An intact lacertus fibrosus improves strength after reinsertion of the distal biceps tendon

Anatomical considerations and clinical implications of bicipital aponeurosis: A magnetic resonance imaging study

The bicipital aponeurosis (BA) is the distal aponeurosis of the biceps brachii which usually covers the median nerve (MN), and the brachial artery (BrA) and sometimes causes compression of these structures. Since these situations are rarely reported in the literature, BA frequently does not come to mind as a cause of such compression. Therefore, the diagnosis may be delayed. In this study, we aimed to investigate the morphometry of BA and its relationship with the surrounding neurovascular structures and to draw attention to BA as a structure that can cause entrapment of the MN and rarely, the BrA. We examined the MRIs of the elbow of 279 patients (107 women, 172 men) aged between 18 and 72 years. We measured the thickness, length and width of BA, and investigated the anatomical relationship between BA, BrA, and MN. The respective median thickness, width, and length of BA were 0.7 (0.4-1.8 mm), 18.0 (6.0-34.0 mm), and 32.0 (18.0-50.0 mm), respectively. In all sections examined, the BA covered the BrA and MN, and was located immediately anterior to the BrA. In 225 (80.6%) of 279 MRIs, the BrA was located anterior to the MN and posterior to the BA. In the remaining 54 (19.4%) MRIs, the MN was located anterior to the BrA and posterior to the BA. The respective median thickness, width, and length of the BA were 0.7 mm, 18.0 mm, and 32.0 mm, respectively. It covered the BrA and MN and was located immediately anterior to the BrA. The BA sometimes causes compression syndromes of these structures, therefore, for physicians, it is important to understand the anatomy of the BA.

Biceps Brachii Distal Tendon Ruptures: Conservative and Surgical Treatment Outcomes

Background. Interest in the study of the distal biceps brachii tendon ruptures in the recent decade has been caused by the development of instrumental diagnostic methods, the new sports disciplines appear and by the technological workplace environment complication. The main concepts of treatment depend on the injury term, the tendon tissue damage area, the patient functional needs and his/her professional activities, the comorbidity index (CCI), so the concepts are divided into two: conservative and surgical. The aim of the study to identify the most effective method of treating patients with a biceps brachii distal tendon rupture. Methods. The study included 58 patients (all men) with a biceps brachii distal tendon injury. They were divided into groups depending on the concept of treatment: a conservative treatment group 20 (34%) patients and a surgical treatment group 38 (66%). The surgical treatment group was also divided into subgroups according to surgical approaches, reinsertion methods and types of fixation. Patients underwent physical tests (ODriscoll, Ruland, et al.), ultrasound to compare the proximal radio-ulnar space, degree of muscle retraction, lacertus fibrosus involvement, and MRI of the elbow joint. The functional scales VAS, DASH and ASES were used to evaluate the obtained results. The results of instrumental diagnostic methods were evaluated with the L. Perera (2012) and J. Fuente (2018) classifications. Results. Evaluation of the results in the groups of surgical (Ns) and conservative (Nc) treatment according to functional scales after 6 (VAS, DASH) and 36 months (ASES) revealed: a decrease in subjective pain score 1 point, a decrease in DASH to 21 and 43 points (statistically significant decrease in both groups p0.001, difference between groups p = 0.005), ASES: 91 and 71 points (dynamics in both groups and difference between groups p 0.001). Minimally invasive approaches compared with open access (nD) showed better functional outcomes according to the DASH scale: nBA vs nD p = 0.006; nMA vs nD p = 0.013 after 6 months, and according to the ASES scale: nBA vs nD p = 0.007; nBA vs nD p= 0.002 after 36 months. An reinsertion methods intragroup analysis revealed the achievement of peak indicators by 6 weeks without complications in the anatomical variant according to the VAS: nBA vs nMA p = 0.264; DASH: nBA vs nMA p = 0.856; ASES nBA vs nMA p = 0.179. Conclusion. Comparison within subgroups made it possible to identify the most effective technique combination of minimally invasive access with an anatomical version of intracanal fixation with a cortical button. This technique has shown to have a low risk of postoperative complications.

Magnetic resonance imaging of the elbow

Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. This article aims to describe the normal imaging anatomy and biomechanics of the elbow, the most commonly used MRI protocols and techniques, and common MRI findings related to tendinopathy, ligamentous and osteochondral injuries, and instability of the elbow.