Greater radial tuberosity size is associated with distal biceps tendon rupture: a quantitative 3-D CT case–control study

Purpose During pronation, the distal biceps tendon and radial tuberosity internally rotate into the radioulnar space, reducing the linear distance between the radius and ulna by approximately 50%. This leaves a small space for the distal biceps tendon to move in and could possibly cause mechanical impingement or rubbing of the distal biceps tendon. Hypertrophy of the radial tuberosity potentially increases the risk of mechanical impingement of the distal biceps tendon. The purpose of our study was to determine if radial tuberosity size is associated with rupturing of the distal biceps tendon. Methods Nine patients with a distal biceps tendon rupture who underwent CT were matched 1:2 to controls without distal biceps pathology. A quantitative 3-dimensional CT technique was used to calculate the following radial tuberosity characteristics: 1) volume in mm3, 2) surface area in mm2, 3) maximum height in mm and 4) location (distance in mm from the articular surface of the radial head). Results Analysis of the 3-dimensional radial tuberosity CT-models showed larger radial tuberosity volume and maximum height in the distal biceps tendon rupture group compared to the control group. Mean radial tuberosity volume in the rupture-group was 705 mm3 (SD: 222 mm3) compared to 541 mm3 (SD: 184 mm3) in the control group (p = 0.033). Mean radial tuberosity maximum height in the rupture-group was 4.6 mm (SD: 0.9 mm) compared to 3.7 mm (SD: 1.1 mm) in the control group, respectively (p = 0.011). There was no statistically significant difference in radial tuberosity surface area (ns) and radial tuberosity location (ns). Conclusion Radial tuberosity volume and maximum height were significantly greater in patients with distal biceps tendon ruptures compared to matched controls without distal biceps tendon pathology. This supports the theory that hypertrophy of the radial tuberosity plays a role in developing distal biceps tendon pathology. Level of evidence Level III.

REINSERTION OF THE DISTAL TENDON OF A BICEPS USING ENDOBUTTON FROM A SINGLE INCISION TECHNIQUE

Summary. Surgical treatment of biceps distal tendon ruptures shows better functional results, compared to a conservative treatment. Recently, the one-incision surgical technique is becoming more and more popular. Task of the study: representation of a technique to recover a distal biceps tendon with a single incision and fixation with an Endobutton. Materials and methods: the single-incision technique for a distal biceps tendon recovery comprises of several steps: an incision place and layer-wise access, preparation of the distal biceps tendon, preparation of the radial tuberosity, fixation of the tendon. Results. The knowledge of anatomy and the correct sequence of steps in the single-incision technique with the fixation of a tendon with Endobutton (by ChM) makes the recovery of distal biceps tendon efficient, reliable, and, what is more important, safe.

Additional head of biceps brachii: a cadaveric study

Background: The biceps brachii is an important muscle of anterior compartment of arm. It shows frequent anatomic variability due to presence of supernumerary heads. Knowledge of the existence of the third head of biceps brachii is important for surgeons. Keeping this in mind a study was planned to see the incidence of additional head of biceps brachii in sample Indian population and to compare it with other racial groups.Methods: The study was carried out on 30 cadaveric upper limbs. The upper limbs were dissected and studied for the presence of additional head of biceps brachii. The attachment and nerve supply of the additional head was carefully observed, recorded and documented.Results: Out of 30 limbs which were dissected, additional head of biceps brachii was found only in two limbs. In both the cases the additional head was present only on the right side and arose from the anterior surface of humerus, superomedial to the origin of brachialis. The additional head fused with the common bulk of the muscle and was inserted into the radial tuberosity and bicipital aponeurosis. The extra heads of biceps brachii muscle received branches from musculocutaneous nerve.Conclusions: Biceps brachii is one of the commonest muscles showing variations. The additional head is not only of academic importance, but its knowledge also helps clinicians in managing fractures of humerus and nerve entrapment.

Reconstruction with interference screw of ruptured distal biceps brachii tendon at level of insertion into radial tuberosity: a case report

Distal biceps tendon rupture is a relatively rare injury. The incidence of distal biceps rupture is 1.2 cases per 100,000 patients per year, with the average age is 47 years old and the majority is male patient with dominant extremity. A 43 years old male presented with pain of the left elbow and weakness to flex and supinate the forearm following gymnastic activity. He heard pop sound on his left elbow during lifting dumbbell and followed by a sudden pain on his arm and weakness to flex and supinate the elbow. The USG examination were performed and confirmed there was a rupture on the distal biceps tendon at the level of insertion. Durante operation confirmed a complete rupture of distal biceps tendon. A Henry approach incision is performed to expose radial tuberosity, and the ruptured tendon was reconstructed by anchored into the tuberosity of radius with bioabsorbable screw. After closing the incision, patient is immobilized by cast in 60 to 90o elbow flexion and neutral pronosupination. Distal biceps tendon rupture can be successfully repaired by single anterior approach using anatomical anchor on radial tuberosity, so that can avoid posterior approach and associated proximal radioulnar synostosis risk while conserving interosseous membrane.

Variations of Biceps Brachii Muscle and its Clinical Importance

Introduction: Biceps brachii is one of the functionally important muscles of front of the arm. As the name indicates biceps brachii is having two heads of origin and it inserts on the posterior surface of radial tuberosity. Variations may be present in the form of additional heads of origin or they may be present at its insertion. These variations may affect action of muscle and may cause compression of nearby neurovascular structures. Aim: To determine the variation in anatomy of biceps brachii with respect to its origin, insertion and its nerve supply. Materials and Methods: The present osteological study was conducted on 32 arms of embalmed cadavers (including both right and left) of Department of Anatomy, SRMS IMS, Bareilly, Uttar Pradesh, India from 2015-2018 period. The dissection of arm was done according to standard guidelines and biceps brachii muscle was cleaned. The origin, insertion and nerve supply of biceps brachii muscle was observed and noted for any variation. Results: In the present study an additional head of origin of biceps on right and left side of two cadavers were found. In present study inferomedial origin of biceps brachii was found. The present study also showed the presence of musculotendinous slip at its insertion. This slip was going towards the muscle belly of pronator teres. Conclusion: There are numerous variations seen in biceps brachii which can put a surgeon in dilemma and it may result in iatrogenic injuries. Hence, it is important to have a knowledge about its variations so that such injuries can be prevented.

Bioarchaeological Analysis of the Mounted Archers from the Hungarian Conquest Period (10th Century)

In certain conditions, some changes observed on human bones can be related to activities practiced during life. Scholars have considered the reconstruction of activities from skeletal changes in past populations as “Bioarchaeology’s Holy Grail”. Horse riding, in particular, has interested bioarchaeologists and paleopathologists for several decades as it brought profound and lasting changes in the history of human cultural evolution. However, the existence of various confounding factors and the lack of clear contextual evidence in connection with the skeletal remains often result in limited or unreliable interpretations of skeletal changes in terms of specific activities. Archaeological and historical sources attest that tribes of semi-nomadic populations conquered the Carpathian Basin with powerful armies of mounted archers at the turn of the 9th and 10th centuries, which led to the foundation of the Kingdom of Hungary in the year 1000/1001. Cemeteries from that period often provide cases of deposits of archery and horse riding equipment as well as horse bones associated with the individuals in the graves. Those populations are, thus, among the most pertinent to be used to perform methodological investigations on activity-related skeletal changes, and, on horse riding, in particular. We selected a sample of 67 individuals from the 10th-century Hungarian cemetery of Sárrétudvari-Hízóföld, in order to analyze the individuals according to the presence or absence of riding deposit in their grave. A modern comparison group of 47 presumed non-rider individuals from the documented collection of Lisbon was also selected. Only adult males were included to limit the effect of sex and age on the changes. The main objectives were to identify skeletal changes reliably related to the practice of horse riding and to improve our understanding of the populations from the Hungarian Conquest period. Various types of skeletal changes were analyzed, including some entheseal changes (at muscles attachment sites), joint changes, vertebral changes, morphological variants, and traumatic lesions. Measurements of the lower limb bones were also used to calculate indices of shape and robusticity. Statistical analyses mostly revealed significant differences between the Hungarian groups with or without riding deposit and the comparison group from Lisbon. They concerned especially some entheseal changes at the coxal bone, femur, tibia, and calcaneus, a morphological adaptation on the femoral neck, intervertebral disc herniations at the thoracolumbar junction, or the ovalization of the acetabulum on the coxal bone. All these traits can be linked to the riding posture, and, thus, seem to be promising indicators for the practice of horse riding. On another note, comparisons between groups revealed that the Hungarian individuals without deposit in their grave were likely riding horses as well. Among the limitations calling for caution is the restricted size of our archaeological samples, which is one of the points that should be improved in the future. In addition, some skeletal changes, such as the entheseal changes, have a multifactorial etiology, which represents a limitation for their interpretation. In that regard, we performed the exploratory analysis of the microarchitecture of an enthesis, the radial tuberosity. Using micro-CT acquisitions and 3D reconstructions of the canals of the cortical bone, we observed that some microstructural variations could allow, with further research, distinguishing entheseal changes related to activity from those related to other factors, thus contributing to more reliable reconstructions of the activities in past populations. In the end, we emphasize that the selection of a pertinent anthropological collection, with direct evidence of the practice of an activity, and the application of strict methodological criteria, are determinant factors for the reliable identification of activity-related skeletal changes.

Treatment of Distal Biceps Tendon Injuries with Particular Emphasis on Postoperative Physiotherapy

Distal biceps tendon injuries are relatively rare. Standard treatment of complete tears and significant partial tears involves surgical anatomical reinsertion of the tendon at the radial tuberosity. Chronic injuries are usually managed with surgical tendon reconstruction using autografts or allografts. Conservative treatment is mostly limited to the elderly, individuals with a very low level of physical activity, patients with evident contraindications to surgical treat­ment, and cases of mild partial tendon tears. The selection of an optimum surgical technique and method of fixation remains controversial. The aim of this paper is to characterize distal biceps tendon injuries, discuss methods of their surgical treatment, and analyze postoperative physiotherapy regimens described in the literature. A literature review did not reveal any relationship between the surgical method and type of fixation used on the one hand and the period of immobilization, type of immobilization, or the postoperative physiotherapy regimen on the other.