Biceps Brachii Muscle Ultrasound

Move the arm in flexion and extension to see the real time movement of the muscle if the patient have no severe pain. Make sure that the tendons are intact, not thickened, check for hypermia , fluid , tend sheath cysts,  tenosenovitis, calcification and tendinosis.

Tendon ruptures of the biceps brachii, one of the dominant muscles of the arm, have been reported in the United States with increasing frequency. Ruptures of the proximal biceps tendon make up 90-97% of all biceps ruptures and almost exclusively involve the long head.

proximal biceps tendon at shoulder level.

Anatomy

Because of its size and its orientation about the shoulder and elbow joints, the biceps muscle is involved in functional activities of the upper limb. At its proximal attachment, the biceps has 2 distinct tendinous insertions on the scapula from its long and short heads. The short head arises from the coracoid process with the coracobrachialis, while the long head originates from the supraglenoid tubercle and passes over the humeral head within the capsule of the glenohumeral joint (see image below).

Biceps muscle and tendons

The biceps muscle then continues down the arm within the intertubercular groove, covered by a synovial out pouching of the joint capsule. The 2 muscle bellies unite near the mid shaft of the humerus and attach distally on the radial tuberosity.

The distal tendon blends with the bicipital aponeurosis, which affords protection to structures of the cubital fossa, allowing distribution of forces across the elbow to lessen the pull on the radial tuberosity. The biceps receives innervation via the musculocutaneous nerve (C5 , C6) from the lateral cord of the brachial plexus.

The biceps muscle and its tendons are some of the most superficial structures of the arm. These structures account for a significant portion of shoulder injuries and a smaller number of elbow injuries. As mentioned, rupture of the proximal biceps tendon comprises 90-97% of all biceps ruptures and almost exclusively involves the long head. Tendon rupture typically occurs at the bony attachment or tendon-labral junction. The remaining ruptures occur distally at the insertion on the radial tuberosity or, even less commonly, at the short-head insertion on the acromion.

Overall consequences of biceps rupture may differ among various demographic groups. The major impairment resulting from proximal biceps rupture involves limitations due to pain during the acute phase, but impairment ultimately relates to a decrease in strength during shoulder flexion, elbow flexion, and forearm supination. Distal ruptures also initially result in pain, followed by reduced strength in supination, elbow flexion, and grip strength.

Patients with biceps rupture may report a wide variety of symptoms, including the following:

• Some patients report a sudden pain in the anterior shoulder during activity. This acute pain, frequently described as sharp in nature, may be accompanied by an audible pop or a perceived snapping sensation.

• Other persons may report experiencing recurrent pain while performing overhead or repetitive activities.
• Still others experience a nondescript anterior shoulder soreness that may worsen at night.
• Patients also may be asymptomatic and note only a visible or palpable mass between the shoulder and elbow. Pain actually may diminish when complete rupture occurs following chronic impingement and irritation. Distal ruptures may present in a similar fashion, but in most of these cases, symptoms or noticeable masses are located closer to the elbow.

• When biceps rupture is suggested on the basis of history or mechanism of injury, physical examination should include specific testing of all types of shoulder and elbow pathology within the large list of possible diagnoses. Because biceps rupture is often the final event in a cascade of impingement and inflammation, testing for impingement syndromes and bicipital tendinitis always is warranted. A thorough examination should include evaluation for several possible signs.
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( Grade the ruptures).

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  • Perform an examination to identify any palpable tenderness along the course of the biceps tendons and muscle belly, including the bicipital groove with the arm in 5-10 º of internal rotation.
  • Perform range-of-motion (ROM) testing of the shoulder and elbow.
  • Perform complete strength testing of upper limb muscles, especially the biceps.

 

• Inspect the shoulder and arm contour and compare with the contralateral side:

• Pay special attention to the region of the bicipital groove, which may show indentation or hollowing when the tendon is absent following a rupture.

• ( Linear biceps muscle rupture )
• The Ludington test (or position), in which the hands are clasped behind the head and the biceps muscles are flexed, often is used for this purpose.
• Other maneuvers, such as the Speed test and Yergason sign, are used, along with signs of biceps dislocation or instability, to identify patients who may have partial tears or who may be predisposed to future rupture.

• (Biceps muscle rupture grade 3 ) .

 

• • A proximal biceps rupture generally is caused by insidious inflammation from impingement in the subacromial region and may be the eventual result of chronic microtrauma in this manner. Repeated insults often lead to fraying of the tendon, with resultant weakness predisposing it to rupture following relatively minor injuries.

• A tendon rupture due to chronic inflammation can occur in rheumatoid arthritis.
• • Excessive loading or rapid stress upon the tendon, such as in weightlifting, often causes an acute tendon rupture.
  • • Biceps tendon rupture or degeneration frequently is associated with rotator cuff trauma in the geriatric population and is often observed at the time of surgery for complete rotator cuff tears. This may be related to impingement phenomenon.
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• ( When  the proximal biceps tendon rupture the patient have this sign )

 

 

 

 

 

try to avoid Anistropy. Or mentioned it in the image.

always check the proximal biceps tend and then the distal at elbow.

• Most ruptures occur at the tendinous insertion to the bony anchor, proximally and distally:
• Distal avulsions from the radius commonly are caused by chronic irritation on an irregular surface, such as in persistent cubital bursitis.
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  Thanks you for reading.

      Steve Ramsey, PhD.  Calgary, Alberta, Canada.