male presenting with antecubital pain while weight liftingbonepit.com/cases/bifurcated distal...
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Male presenting with antecubital pain while weight lifting
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Findings
• Congenitally bifid appearance of the distal biceps to its radial tuberosity attachment – Tendinosis of both heads
– Low grade partial tearing of the short head of biceps tendon just proximal to the radial tuberosity
• High signal surrounding both heads of the distal biceps tendon, compatible with cubital bursitis including the bicipitoradial and interosseous bursae
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Bifurcated Distal Biceps…as a means to understand distal biceps tendon anatomy
AJR 2008; 191:W248-255
JBJS 2007; 89:1044-9
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Bifurcated Distal Biceps…as a means to understand distal biceps tendon anatomy • Origin:
– Long head: supraglenoid tubercle
– Short head: coracoid process
• Decussation proximal to the elbow – “goose’s quill”
• Send contributions to lacertus fibrosis to ulnar aspect of elbow
AJR 2008; 191:W248-255
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Bifurcated Distal Biceps…as a means to understand distal biceps tendon anatomy • Distal tendon descent
– Even when common tendon, short and long head components were macroscopically identifiable
– Long head – radial
– Short head – ulnar
• Footprint – Long head – passes deep to short
head tendon to insert proximally; ovoid; larger footprint
– Short head – distal insertion; fan-like
AJR 2008; 191:W248-255
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Bifurcated Distal Biceps…as a means to understand distal biceps tendon anatomy
• Distal tendon descent
– Long head – radial
– Short head – ulnar
• Footprint
– Long head – passes deep to short head tendon to insert proximally (supination); ovoid; larger footprint
– Short head – distal insertion (flexion); fan-like
JBJS 2007; 89:1044-9
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Going back to our case, can we reinforce this anatomy?
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Long head Short head
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Findings
• Congenitally bifid appearance of the distal biceps to its radial tuberosity attachment – Tendinosis of both heads
– Low grade partial tearing of the short head of biceps tendon just proximal to the radial tuberosity
• High signal surrounding both heads of the distal biceps tendon, compatible with cubital bursitis including the bicipitoradial and interosseous bursae
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Cubital Bursae
• Bicipitoradial bursa – Anterior to radial tuberosity
– Intimate with biceps tendon
insertion
– Compressed with pronation
– When large, can compress adj nerves (usu sup or deep br radial nerve)
• Interosseous bursa
Resnick. Radiology 1999; 212: 111-116
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Cubital Bursae
• Bicipitoradial bursa
• Interosseous bursa
– 20% of individuals
– Medial aspect of antecubital fossa, adj to biceps tendon and along the brachialis muscle
Resnick. Radiology 1999; 212: 111-116