Ultrasound of the distal biceps brachii tendon using four approaches: reproducibility and reader preference
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SCIENTIFIC ARTICLE
Ultrasound of the distal biceps brachii tendon using four approaches: reproducibility and reader preference Theodore T. Miller 1 & Gabrielle P. Konin 1 & Joseph T. Nguyen 2 & Shefali Kothary 1,3 & Ogonna K. Nwawka 1 & Yoshimi Endo 1 & Gregory R. Saboeiro 1 Received: 29 June 2020 / Revised: 18 August 2020 / Accepted: 30 September 2020 # ISS 2020
Abstract Objectives To determine which sonographic appearance of the distal biceps brachii tendon (DBBT) is preferred by readers, and if images obtained by two different operators are reproducible. Methods We performed an IRB-approved prospective sonographic evaluation of the DBBT in 50 healthy elbows using four different approaches (anterior, lateral, medial, posterior) performed by two operators. Five musculoskeletal radiologists independently reviewed the images, and ranked the four approaches based on overall appearance of echogenicity of the tendon, visualized length, and visualization of the insertion. Results The medial approach was preferred in 79.6% of elbows, anterior in 17.6%, lateral in 2.8%, and the posterior approach was never preferred. The difference was statistically significant (P < 0.001). Kappa values for the five readers were 0.61 to 0.8 for choosing the images produced by the medial approach. Conclusion The appearance of the DBBT using the medial approach is preferred by readers and is reproducible between different operators. Keywords Ultrasound . Biceps . Tendon . Elbow . Distal . Sonography
Introduction Rupture of the distal biceps brachii tendon (DBBT) is a rare injury that occurs almost exclusively in males, predominantly involves the dominant upper arm, and is typically caused by an eccentric load on the flexed elbow [1, 2]. In active adults, functional outcomes of the repaired tendon are better than those managed conservatively [1–3], thus requiring accurate diagnosis.
Initial descriptions of sonography of the DBBT used an anterior approach with the elbow extended, and the transducer placed longitudinally at the antecubital fossa and proximal forearm [4–6]. However, difficulty in visualizing the distal attachment because of anisotropy using the anterior approach led to descriptions of visualization using a posterior approach [7], a lateral approach [8], and a medial approach [9]. These techniques have become incorporated into the sonographic assessment of the distal biceps tendon and may be considered
* Theodore T. Miller [email protected]
Yoshimi Endo [email protected] Gregory R. Saboeiro [email protected]
Gabrielle P. Konin [email protected] Joseph T. Nguyen [email protected]
1
Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
Shefali Kothary [email protected]
2
Biostatistics Core, Research Division, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA
Ogonna K. Nwawka [email protected]
3
Present address: Zwanger-Persiri Radiology, 150 Sunrise Highway, Lindenhurst, NY 11757, USA
Skeletal Radiol
complementary [10], but lack data regard
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