elbow mri brachialis tendon tears tendinosis radiology education asia


BRACHIALIS TENDON MRI: Elbow MRI Brachialis tendon Tendinosis, Tears and Normal


The Brachialis tendon is less commonly injured than the biceps.  It inserts onto the anterior ulnar on the ulnar tuberosity and to a lesser extent on the coronoid process but the tendon is very short compared to the biceps tendon. Most commonly we see tendinosis or a strain/partial tear at the musical tendinous junction. Complete ruptures are uncommon.

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    • Where does the brachialis tendon insert? 

    • The Brachialis tendon inserts predominantly on the ulna tuberosity (Yellow circle and arrow) with some fibres extending to the coronoid process.

    • (Image credit First Image Bartleby.com: Gray's Anatomy, Plate 213, 2nd Image Source unknown please inform us if this is yours and we will acknowledge).

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  • The Normal Brachialis tendon (blue arrow) should be black on all sequences like all tendons. Its separate to the Biceps tendon (yellow arrow).

  • The second image is a sagittal scan, and demonstrates a broad tendon attachment (blue arrow) with a very short tendon length.

  • Brachialis muscle (red arrow).

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  • Brachialis tendinosis on MRI has the standard appearance of tendinosis in any tendon.

  • Look for intermediate increased PDFS signal within tendon and there may also be peritendinous oedema (blue arrow).

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  • Brachialis tendon (yellow arrow) is dark signal proximally (first image) but is barely seen more distally due to tendinosis and delamination.

  • Compare the signal with normal low signal of the biceps tendon (blue arrow). 

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  • There is a Brachialis musculotendinous junction (MTJ) strain and partial tearing at the junction.

  • There is Oedema in muscle and its interface with the tendon at the The MTJ (blue arrow).

  • Brachialis tendon itself (yellow arrow) appears normal. 

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