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Multidisciplinary approach to the persistent double distal tendon of the biceps brachii

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Abstract

Purpose

The aim of this study is to correlate the ultrasound (US) appearance of the persistent double or bifid distal tendon of the biceps brachii muscle with anatomical and histological data. This will provide a new model to study the pathological distal biceps brachii tendon (DBBT).

Methods

The DBBT of 20 cadaveric elbows were examined with linear array broadband US transducers (frequency band 14–6 MHz) using an anterior approach. Trypan blue dye was injected underneath the paratenon under US guidance in 16 specimens. After they were dissected, five of them were processed to obtain histological slices stained with hematoxylin–eosin and antiserum to protein S100.

Results

At US, the DBBT is a tendon in which the fascicles are organized in two different hyperechoic components separated by a hyperechoic septum related to the endotenon. The endotenon is lax, flexible, and makes folding and gliding of the two portions feasible. The DBBT is surrounded by a hyperechoic paratenon adjacent to the tendon surface, which is only differentiable by US when dye is interposed between such structures.

Conclusions

The connective septum of endotenon located between the two main components of the DBBT is responsible for the US image of two separate tendons and functionally enables it to work as two separate entities, thus allowing respective folding and gliding. The paratenon surrounding the lacertus fibrosus and the DBBT plays an important stabilization role, enabling them to change shape and arrangement during joint motion. It is also an important conduit for nerves and blood vessels.

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References

  1. Athwal GS, Steinmann SP, Rispoli DM (2007) The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am 32(8):1225–1229. doi:10.1016/j.jhsa.2007.05.027

    Article  PubMed  Google Scholar 

  2. Benjamin M, Kaiser E, Milz S (2008) Structure-function relationships in tendons: a review. J Anat 212(3):211–228. doi:10.1111/j.1469-7580.2008.00864.x

    Article  CAS  PubMed  Google Scholar 

  3. Benjamin M, Newell RL, Evans EJ, Ralphs JR, Pemberton DJ (1992) The structure of the insertions of the tendons of biceps brachii, triceps, and brachialis in elderly dissecting room cadavers. J Anat 180(Pt 2):327–332

    PubMed  Google Scholar 

  4. Cho CH, Song KS, Choi IJ, Kim DK, Lee JH, Kim HT, Moon YS (2011) Insertional anatomy and clinical relevance of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc 19(11):1930–1935. doi:10.1007/s00167-011-1586-x

    Article  PubMed  Google Scholar 

  5. Cho CH, Song KS, Lee SM (2011) Isolated short head component rupture of a bifurcated distal biceps tendon mimicking as a complete rupture. J Hand Surg Eur Vol 36(4):333–334. doi:10.1177/1753193411402002

    Article  PubMed  Google Scholar 

  6. Cucca YY, McLay SV, Okamoto T, Ecker J, McMenamin PG (2010) The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat 32(4):371–375. doi:10.1007/s00276-009-0575-y

    Article  CAS  PubMed  Google Scholar 

  7. Dirim B, Brouha SS, Pretterklieber ML, Wolff KS, Frank A, Pathria MN, Chung CB (2008) Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol 191(6):W248–W255. doi:10.2214/AJR.08.1048

    Article  PubMed  Google Scholar 

  8. Domingo T, Blasi J, Casals M, Mayoral V, Ortiz-Sagrista JC, Miguel-Perez M (2011) Is interfascial block with ultrasound-guided puncture useful in treatment of myofascial pain of the trapezius muscle? Clin J Pain 27(4):297–303. doi:10.1097/AJP.0b013e3182021612

    Article  PubMed  Google Scholar 

  9. Eames MH, Bain GI, Fogg QA, van Riet RP (2007) Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am 89(5):1044–1049. doi:10.2106/JBJS.D.02992

    Article  CAS  PubMed  Google Scholar 

  10. Fallon J, Blevins FT, Vogel K, Trotter J (2002) Functional morphology of the supraspinatus tendon. J Orthop Res 20(5):920–926. doi:10.1016/S0736-0266(02)00023-2

    Article  PubMed  Google Scholar 

  11. Fogg QA, Hess BR, Rodgers KG, Ashwood N (2009) Distal biceps brachii tendon anatomy revisited from a surgical perspective. Clin Anat 22(3):346–351. doi:10.1002/ca.20786

    Article  PubMed  Google Scholar 

  12. Franchi M, Trire A, Quaranta M, Orsini E, Ottani V (2007) Collagen structure of tendon relates to function. Sci World J 7:404–420. doi:10.1100/tsw.2007.92

    Article  CAS  Google Scholar 

  13. Giombini A, Innocenzi L, Di Cesare A, Di Salvo W, Fagnani F, Pigozzi F (2007) Partial rupture of the distal biceps brachii tendon in elite waterpolo goalkeeper: a case report of conservative treatment. J Sports Med Phys Fit 47(1):79–83

    CAS  Google Scholar 

  14. Giuffre BM, Lisle DA (2005) Tear of the distal biceps branchii tendon: a new method of ultrasound evaluation. Australas Radiol 49(5):404–406. doi:10.1111/j.1440-1673.2005.01469.x

    Article  CAS  PubMed  Google Scholar 

  15. Jarrett CD, Weir DM, Stuffmann ES, Jain S, Miller MC, Schmidt CC (2012) Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Should Elb Surg 21(7):942–948. doi:10.1016/j.jse.2011.04.030

    Article  Google Scholar 

  16. Kalume Brigido M, De Maeseneer M, Jacobson JA, Jamadar DA, Morag Y, Marcelis S (2009) Improved visualization of the radial insertion of the biceps tendon at ultrasound with a lateral approach. Eur Radiol 19(7):1817–1821. doi:10.1007/s00330-009-1321-x

    Article  PubMed  Google Scholar 

  17. Kannus P (2000) Structure of the tendon connective tissue. Scand J Med Sci Sports 10(6):312–320

    Article  CAS  PubMed  Google Scholar 

  18. Kayser R, Mahlfeld K, Scheller W, Muller J, Schmidt W, Heyde CE (2005) Sonographic imaging of the distal biceps tendon—an experimental and clinical study. Ultraschall Med 26(1):17–23. doi:10.1055/s-2004-813718

    Article  CAS  PubMed  Google Scholar 

  19. Keener JD (2011) Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. J Should Elb Surg 20(2 Suppl):S113–S125. doi:10.1016/j.jse.2010.11.009

    Article  Google Scholar 

  20. Kulshreshtha R, Singh R, Sinha J, Hall S (2007) Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res 456:117–120. doi:10.1097/BLO.0b013e31802f78aa

    Article  PubMed  Google Scholar 

  21. Sassmannshausen G, Mair SD, Blazar PE (2004) Rupture of a bifurcated distal biceps tendon. A case report. J Bone Joint Surg Am Vol 86-A(12):2737–2740

    Google Scholar 

  22. Sharma P, Maffulli N (2006) Biology of tendon injury: healing, modeling, and remodeling. J Musculoskelet Neuronal Interact 6(2):181–190

    CAS  PubMed  Google Scholar 

  23. Smith J, Finnoff JT, O’Driscoll SW, Lai JK (2010) Sonographic evaluation of the distal biceps tendon using a medial approach: the pronator window. J Ultrasound Med 29(5):861–865

    PubMed  Google Scholar 

  24. Tagliafico A, Michaud J, Capaccio E, Derchi LE, Martinoli C (2010) Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings. Eur Radiol 20(1):202–208. doi:10.1007/s00330-009-1524-1

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are thankful to body donors that enable the study of anatomy. We also thank Nieves Cayuela and Eva Sanchez for their help and assistance in the laboratory. Supported by grants ACESB08/09 (Faculty of Medicine, C. Bellvitge, University of Barcelona) and 2009SGR152 (AGAUR, Generalitat de Catalunya, Spain).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, University of Barcelona, Barcelona, Spain

    Marc Blasi & Tomás Domingo

  2. Àrea d’Estructura i Funció del Cos Humà, Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain

    Marc Blasi & Albert Pérez-Bellmunt

  3. Orthopedic Surgery Department, Clinica Pakea Mutualia, San Sebastian, Spain

    Javier de la Fuente

  4. Cattedra di Radiologia “R”–DICMI, Università di Genova, Genoa, Italy

    Carlo Martinoli

  5. Unit of Histology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine (HSC Bellvitge), IDIBELL, University of Barcelona, Barcelona, Spain

    Juan Blasi

  6. Department of Anaesthesia, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Tomás Domingo

  7. Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine (HSC Bellvitge), University of Barcelona, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain

    Maribel Miguel-Pérez

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  1. Marc Blasi
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  2. Javier de la Fuente
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  3. Carlo Martinoli
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  4. Juan Blasi
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  6. Tomás Domingo
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  7. Maribel Miguel-Pérez
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Correspondence to Maribel Miguel-Pérez.

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Blasi, M., de la Fuente, J., Martinoli, C. et al. Multidisciplinary approach to the persistent double distal tendon of the biceps brachii. Surg Radiol Anat 36, 17–24 (2014). https://doi.org/10.1007/s00276-013-1136-y

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  • DOI: https://doi.org/10.1007/s00276-013-1136-y

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