Bicipital radial bursitis: CT and MR appearance

Endoscopic Resection of the Bicipitoradial Bursa

The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, the presence of nerve compression with neurological impairment, mechanical limitation to flexion and extension of the elbow or biceps tendon degeneration, and/or functional impairment. Open resection through the anterior approach requires extensive dissection to expose the radial tuberosity and the radial neck, which increases the risk of neurovascular injury. Endoscopic resection is possible through distal biceps tendoscopy and endoscopy around the radial neck. It is technically demanding and should be reserved to the experienced elbow arthroscopist.

Preoperative diagnosis of bicipitoradial bursitis: a case report

Inflammation of the bicipitoradial bursa is a rare condition and only few reports can be found in literature. Several causes for a cubital bursitis have been suggested in the past. The need to include a malignant lesion in the differential diagnosis has only been mentioned in one of these reports. May main objective in reporting this case is to make this pathological entity better known.

Bicipitoradial Bursitis: A Review of Clinical Presentation and Treatment

The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis and most often results from repetitive mechanical trauma or overuse. Other causes include tuberculosis, immunological complications of rheumatological disease and synovial chondromatosis. Accurate diagnosis requires imaging studies and sometimes histological study. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in the case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, presence of nerve compression with neurological impairment, mechanical limitation to flexion, and extension of the elbow or biceps tendon degeneration and/or functional impairment.

The aging athlete: part 2, "boomeritis" of the upper extremity

OBJECTIVE

The purpose of this review is to describe the upper extremity injuries that frequently accompany aging, the typical clinical presentations, and the differential diagnoses with an emphasis on the injury most likely encountered with each presentation.

CONCLUSION

Expectation of continued participation in exercise and sports activities by the baby boomer population has presented new challenges to the medical field. The concepts behind factors that predispose older athletes to certain pathologic conditions that affect the muscles, tendons, and bones of the upper extremity must be understood.

The enthesis organ concept and its relevance to the spondyloarthropathies

A characteristic feature of the spondyloarthropathies is inflammation at tendon or ligament attachment sites. This has traditionally been viewed as a focal abnormality, even though the inflammatory reaction intrinsic to enthesitis may be quite extensive. We argue that the diffuse nature of the pathology is best understood in the context of an 'enthesis organ concept'. This highlights the fact that stress concentration at an insertion site involves not only the enthesis itself, but neighbouring tissues as well. The archetypal enthesis organ is that of the Achilles tendon where intermittent contact between tendon and bone immediately proximal to the enthesis leads to the formation of fibrocartilages on the deep surface of the tendon and on the opposing calcaneal tuberosity, but similar functional modifications are widespread throughout the skeleton. Many entheses have bursae and fat near the insertion site and both of these serve to promote frictionless movement. Collectively, the fibrocartilages, bursa, fat pad and the enthesis itself constitute the enthesis organ. However, it also includes both the immediately adjacent trabecular bone networks and in some cases deep fascia. The concept of a synovio-entheseal complex (SEC) and of a 'functional enthesis' are complimentary to that of an enthesis organ and also have important implications for understanding spondyloarthropathy. The SEC concept emphasizes the interdependence between synovial membrane and entheses within enthesis organs. It draws attention to the fact that one component (the enthesis) is prone to microdamage and the other (the synovium) to inflammation. If an enthesis is damaged, any ensuing inflammatory reaction is likely to occur in the synovium. The concept of a 'functional enthesis' serves to emphasise anatomical, biomechanical and pathological features that are shared between true fibrocartilaginous entheses and regions proximal to the attachment sites themselves where tendons or ligaments wrap around bony pulleys. Such'wrap-around regions' are well documented sites of pathology in SpA-for tenosynovitis is a recognized feature. Stress concentration at the enthesis itself is dissipated at many sites by fibrous connections between one tendon or ligament and another, close to the insertion site. At a microscopic level, enthesis fibrocartilage is of paramount importance in ensuring that fibre bending of the tendon or ligament is not focused at the hard tissue interface. Normal enthesis organs are avascular in their fibrocartilaginous regions, but tissue microdamage to entheses is common and appears to be associated with tissue repair responses and vessel ingrowth. This makes the enthesis organ a site where adjuvant molecules derived from bacteria may be preferentially deposited. This microdamage and propensity for bacterial molecule deposition in the context of genetic factors such as HLA-B27 appears to lead to the characteristic inflammatory changes of AS. Understanding the enthesis organ concept helps to explain synovitis and osteitis in spondyloarthropathy. An appreciation of the complex anatomy of 'articular enthesis organs' (e.g., that associated with the distal interphalangeal joints) is helpful in understanding disease patterns in psoriatic arthritis. In this chapter, we review the extent and types ofenthesis organs and show how a patho-anatomic appreciation of these structures leads to a new platform for understanding the pathogenesis of SpA.

[Adolescent bicipitoradial bursitis: a rare disease that can simulate a malignant tumor]

Bicipitoradial bursitis is a rare condition: we found 36 cases reported in the literature, none in children. The main manifestation is a painful tumefaction. We report a case observed in an adolescent whose magnetic resonance imaging findings were compatible with a malignant tumor. Surgical biopsy enabled the correct diagnosis of inflammatory synovium without signs of malignancy compatible with bicipitoradial bursitis. Complete cure was achieved without resection.

Sports-related injuries of the elbow: an approach to MRI interpretation

MRI is a valuable tool for evaluating the athlete with elbow pain, particularly in those with nonlocalizable pain. MRI also is helpful in sorting out the cause of pain in athletes who may have acute trauma superimposed on tendinopathy or other chronic injuries from repetitive microtrauma. Even in athletes in whom the cause of pain confidently can be diagnosed clinically, MRI can document the injury severity, which can be helpful for estimating recovery time or in preoperative planning. By contributing to an accurate early diagnosis, MRI also can help minimize the time that athletes are away from their sports. The authors describe their approach to the MRI interpretation of elbow injuries in athletes, including osteochondral lesions, epicondylitis, and tears of the medial collateral ligament.

Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves

Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears of the ulnar collateral ligament and lateral collateral ligament of the elbow with high sensitivity and specificity. Magnetic resonance imaging can determine the extent of tendon pathology in patients with medial epicondylitis and lateral epicondylitis. Magnetic resonance imaging can detect tears of the biceps tendon and triceps tendon and can distinguishing between partial and complete tendon rupture. Magnetic resonance imaging is also helpful in evaluating patients with nerve disorders at the elbow.

MRI Characteristics of Olecranon Bursitis

OBJECTIVE

Our aim was to describe the MRI characteristics of septic and nonseptic olecranon bursitis.

MATERIALS AND METHODS

MRI contrast-enhanced examinations (n = 19) of 35 patients with olecranon bursitis (septic, n = 14; nonseptic, n = 21) were jointly reviewed by two musculoskeletal radiologists. We evaluated bursa size, extent of marginal lobulation, septation, concomitant elbow joint effusion, soft-tissue edema, rim enhancement, soft-tissue enhancement, degree of fluid complexity, definition of bursa margins, presence of edema, thickening of the triceps tendon, and bone marrow edema.

RESULTS

Comparison of septic and nonseptic bursitis yielded the following results: marginal lobulation, 79% (11/14) versus 48% (10/21), p = 0.14; bursa septation, 64% (9/14) versus 57% (12/21), p = 1.0; moderate or marked complexity of bursa fluid, 64% (9/14) versus 29% (6/21), p = 0.15; poorly defined margins, 64% (9/14) versus 67% (14/21), p = 1.0; elbow joint effusion, 86% (12/14) versus 52% (11/21), p = 0.12; moderate to marked soft-tissue edema, 64% (9/14) versus 33% (7/21), p = 0.1; edema of the triceps, 57% (8/14) versus 48% (10/21), p = 0.73; thickening of the triceps, 43% (6/14) versus 14% (3/21), p = 0.21; bone marrow edema, 29% (4/14) versus 5% (1/21), p = 0.13; rim enhancement, 100% (11/11) versus 75% (6/8), p = 0.31; soft-tissue enhancement, 100% (11/11) versus 63% (5/8), p = 0.1.

CONCLUSION

Septic and nonseptic olecranon bursitis present with a considerable overlap of MRI findings without statistically significant differences. Septic olecranon bursitis can be excluded in the absence of bursal and soft-tissue enhancement.