Distal Biceps Tendon Tear (DBTT)

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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

Pearls

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

References

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

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