Purpose
Magnetic resonance imaging (MRI) is used widely for complete ruptures of the distal
biceps tendon. The validity of this investigation for bicipital bursitis and tendinosis
is unknown. The purpose of present study was to assess the prevalence of incidental
(asymptomatic) signal changes in the distal biceps tendon in patients who underwent
MRI including the elbow. Our null hypothesis was that signal changes of the distal
biceps tendon do not occur in asymptomatic patients. This would empower MRI as a diagnostic
tool for bicipital bursitis and tendinosis as well as complete and partial distal
biceps tendon ruptures.
Methods
We evaluated 1,191 elbow MRI scans including the distal biceps tendon insertion. The
prevalence of incidental findings was calculated and sensitivity, specificity, positive
predictive value, negative predictive value, false positive probability, and false
negative probability were calculated.
Results
Signal changes of the distal biceps tendon or bursitis were identified in 8 of 1,191
asymptomatic patients (prevalence 0.6%). The sensitivity of MRI for distal biceps
pathology was 97% (95% confidence interval [CI], 93%–99%), specificity 99% (95% CI,
98%–99%), positive predictive value 94% (95% CI, 89%–97%), negative predictive value
99% (95% CI, 99%–99%), false positive probability 6% (95% CI, 3%–10%), and false negative
probability 0.3% (95% CI, 0.1%–0.9%). There was no correlation between explanatory
variables, including age, sex, race, occupation, and inflammatory disease and incidental
distal biceps tendon signal changes.
Conclusions
The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients
is very low.
Clinical relevance
The negative predictive value of 99% shows that patients without signal changes on
MRI may be assumed to have no distal biceps tendon pathology. MRI investigation of
distal biceps tendon is a valuable tool in the diagnosis of tendinosis and bicipital
bursitis.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Distal biceps tendinosis: evidence-based review.J Hand Surg Am. 2009; 34: 1124-1126
- Imaging of tendons.Sports Health. 2009; 1: 293-300
- Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system.Eur Radiol. 1999; 9: 1376-1380
- Incidental magnetic resonance imaging signal changes in the extensor carpi radialis brevis origin are more common with age.J Shoulder Elbow Surg. 2016; 25: 1175-1181
- Does rewording MRI reports improve patient understanding and emotional response to a clinical report?.Clin Orthopaed Relat Res. 2013; 471: 3637-3644
- Surgical procedures of the elbow: a nationwide cross-sectional observational study in the United States.Arch Bone Jt Surg. 2015; 3: 13-18
- Rupture of the distal biceps tendon: evaluation with MR imaging.Radiology. 1994; 190: 659-663
- Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture.J Hand Surg Am. 2010; 35: 77-83
- Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view.AJR Am J Roentgenol. 2004; 182: 944-946
- Is the flexion-abduction-supination magnetic resonance imaging view more accurate than standard magnetic resonance imaging in detecting distal biceps pathology?.J Shoulder Elbow Surg. 2020; 29: 2654-2660
- Distal biceps provocation test.J Hand Surg Am. 2021; 46: 710.e1-710.e4
- A novel clinical test for partial tears of the distal biceps brachii tendon: the TILT sign.Clin Anat. 2018; 31: 301-303
- A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.J Shoulder Elbow Surg. 2014; 23: 1913-1921
- Variations of magnetic resonance imaging findings in asymptomatic elbows.J Shoulder Elbow Surg. 2019; 28: S154-S160
Article info
Publication history
Published online: March 25, 2022
Accepted:
January 14,
2022
Received:
April 25,
2021
Footnotes
Dr Riet is a consultant with Acumed. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
