Distal Biceps Tendon Tear (DBTT)

Diagnosis Definition

• Most biceps tendon ruptures are proximal at the shoulder; distal biceps tendon tears (DBTT) at the elbow account for 3-5% of biceps injuries
• DBTT can occur in football players and weightlifters, at or near the tendon’s insertion onto the radial tuberosity resulting from forced hyperextension of flexed and supinated arm

Imaging Findings

• MR imaging is performed in the axial plane with the arm extended, and in the longitudinal plane with the patient lying prone with the arm overhead, the elbow flexed to 90°, and the forearm supinated, so that the thumb points superiorly (FABS—flexed elbow, abducted shoulder, forearm supinated)
• In complete tears, MRI shows discontinuity with or without retraction (best seen on longitudinal FABS); the proximal tendon is enlarged with high signal
• Partial tears are seen as an increase in caliber and abnormal contour with high intratendinous signal
• High signal T2 peritendinous fluid (edema, bursitis, or hemorrhage) may be seen

KEY IMAGES

Pearls

• If the bicipital aponeurosis is intact (best seen on axial view), there may be no tendon retraction

References

1. Alentorn-Geli E, et al. Distal biceps tendon injuries: a clinically relevant current concepts review. EFORT Open Reviews 2016; 1:316-324.
2. Chew ML, Giuffre BM. Disorders of the distal biceps brachii tendon. RadioGraphics 2005; 25:1227-1237.
3. Pomeranz SJ, et al. Category B: Elbow. Gamuts & Pearls in MRI & Orthopedics. 1997; P. 60
4. Sonin AH, et al. MR Imaging of Sports Injuries in the Adult Elbow. American Journal of Roentgenology 1996; 167(327):325-331.