Skip to main content
SpringerLink
Log in

The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 16 August 2023

This article has been updated

Abstract

Objective

To describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography.

Materials and methods

This was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness ≥1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial.

Results

An AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1—this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone—this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures.

Conclusion

A 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Change history

Abbreviations

AEST:

Aponeurotic expansion of the supraspinatus tendon

MR:

Magnetic resonance

SE:

Spin-echo

SLAP:

Superior labral anterior posterior

VIBE:

Volumetric interpolated breath-hold examination

References

  1. Gaskin CM, Golish SR, Blount KJ, Diduch DR. Anomalies of the long head of the biceps brachii tendon: clinical significance, MR arthrographic findings, and arthroscopic correlation in two patients. Skeletal Radiol. 2007;36:785–9.

    Article  PubMed  Google Scholar 

  2. Traverso A, Piasecki K, Gallusser N, Farron A. Agenesis of the long head of the biceps brachii tendon: ignored variations of the anatomy and the next tendon to disappear? BMJ Case Rep. 2020;13:e234962.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lutterbach-Penna RA, Brigido MK, Robertson B, Kim SM, Jacobson J, Fessell DP. Sonography of the accessory head of the biceps brachii. J Ultrasound Med. 2014;33:1851–4.

    Article  PubMed  Google Scholar 

  4. Moser TP, Cardinal E, Bureau NJ, Guillin R, Lanneville P, Grabs D. The aponeurotic expansion of the supraspinatus tendon: anatomy and prevalence in a series of 150 shoulder. Skeletal Radiol. 2015;44:223–31.

    Article  PubMed  Google Scholar 

  5. Moser TP, Bureau NJ, Grabs D, Cardinal É. Accessory head of the biceps tendon versus aponeurotic expansion of the supraspinatus tendon. J Ultrasound Med. 2015;34:173–4.

    Article  PubMed  Google Scholar 

  6. Clark JM, Harryman DT II. Tendons, ligaments, and capsule of the rotator cuff: gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74:713–25.

    Article  CAS  PubMed  Google Scholar 

  7. Brodie CG. Note on the transverse-humeral, coraco-acromial, and coraco-humeral ligaments. J Anat Physiol. 1890;24:247–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Gheno R, Zoner CS, Buck FM, Nico MAC, Haghighi P, Trudell DJ, et al. Accessory head of biceps brachii muscle: anatomy, histology, and MRI in cadavers. AJR Am J Roentgenol. 2010;194:W80–3.

    Article  PubMed  Google Scholar 

  9. Ogul H, Kantarci M, Topal M, Karaca L, Tuncer K, Pirimoglu B, et al. Extra-articular contrast material leaks into locations unrelated to the injection path in shoulder MR arthrography. Eur Radiol. 2014;24:2606–13.

    Article  PubMed  Google Scholar 

  10. Ogul H, Karaca L, Can CE, Pirimogul B, Tuncer K, Topal M, et al. Anatomy, variants, and pathologies of the superior glenohumeral ligament: magnetic resonance imaging with three-dimensional volumetric interpolated breath-hold examination sequence and conventional magnetic resonance arthrography. Korean J Radiol. 2014;15:508–22.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ogul H, Taydas O, Sakci Z, Altinsoy HB, Kantarci M. Posterior shoulder labrocapsular structures in all aspects; 3D volumetric MR arthrography study. Br J Radiol. 2021;94:20201230.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ogul H, Bayraktutan U, Yildirim OS, Suma S, Ozgokce M, Okur A, et al. Magnetic resonance arthrography of the glenohumeral joint: ultrasonography-guided technique using a posterior approach. Eurasian J Med. 2012;44:73–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Akkaya Z, Coruh AG, Bas H, Gokmen D, Sahin G. A new significance of an old structure: aponeurotic expansion of supraspinatus tendon and its relationships with biceps brachii long head and rotator cuff tendons. Eur J Radiol. 2020;133:109374.

    Article  PubMed  Google Scholar 

  14. Hammad RB, Mohamed A. Unilateral four-headed pectoralis muscle major. Mcgill J Med. 2006;9:28–30.

    PubMed  PubMed Central  Google Scholar 

  15. Ogul H, Tas N, Tuncer K, Polat G, Ogul Y, Pirimoglu B, et al. 3D volumetric MR arthrographic assessment of shoulder joint capacity in patients with primary adhesive capsulitis. Br J Radiol. 2019;92:20180496.

    Article  PubMed  Google Scholar 

  16. Kim KC, Rhee KJ, Shin HD, Kim YM. Biceps long head tendon revisited: a case report of split tendon arising from single origin. Arch Orthop Trauma Surg. 2008;128:495–8.

    Article  PubMed  Google Scholar 

  17. Warner JJ, Paletta GA, Warren RF. Accessory head of the biceps brachii: case report showing clinical relevance. Clin Orthop Relat Res. 1992;280:179–81.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Medical Faculty, Duzce University, 81000, Duzce, Turkey

    Derya Guclu, Hayri Ogul & Elif Nisa Unlu

  2. Department of Orthopedic Surgery, Medical Faculty, Altinbas University, Istanbul, Turkey

    Kutsi Tuncer & Mehmet Kose

  3. Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey

    Mecit Kantarci & Suat Eren

Authors
  1. Derya Guclu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hayri Ogul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elif Nisa Unlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kutsi Tuncer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet Kose
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mecit Kantarci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suat Eren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hayri Ogul.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The ​original ​version ​of ​this ​article ​was ​revised. In figure 1, the correct data should be: 18 MR arthrograms instead of 8 MR arthrograms.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guclu, D., Ogul, H., Unlu, E.N. et al. The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort. Skeletal Radiol 53, 365–374 (2024). https://doi.org/10.1007/s00256-023-04409-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-023-04409-1

Keywords

Search

Navigation