With distal biceps tendon injuries, early diagnosis of tendon tear or rupture with high-resolution ultrasound is key to early treatment and better outcomes. SonoSkills educator Mr. Schmitz demonstrates techniques using high-definition wireless ultrasound to diagnose tendon pathologies without relying on other medical imaging modalities.

Scanning the distal bicep tendon and insertion onto the radial tuberosity can be challenging due to its small size, deep location, and oblique course. Additionally, the surrounding structures such as the radial tuberosity, brachialis muscle, and bicipital aponeurosis can create artifacts and obscure visualization. For these reasons, accurate assessment has historically required a combination of imaging modalities including MRI and CT. Mr. Schmitz demonstrates eight approaches for a thorough, accurate, and confident point-of-care ultrasound assessment to limit dependance on other imaging modalities.

Mr. Schmitz demonstrates the ventral approach, providing a look at the bicep tendon and the lacertus fibrosus. With proper patient positioning, the tendon is then be examined in transverse, where it can be seen between the brachial artery and cephalic vein, and in long axis, where fluid in or around the tendon can be easily identified.

Examination of the bicep tendon from the dorsal approach is a favorite for Mr. Schmitz. He’ll show how to perform the exam with the patient’s arm in a “cobra” position, which provides access to the bicep tendon insertion onto the radial tuberosity. He localizes the tendon and then performs both static and dynamic assessments to look for bursitis and impingement, and in long axis, visualize the broad tendon insertion.

Mr. Schmitz demonstrates the lateral approach, which is great for evaluating the distal tendon, not including the insertion. Dynamic pro- and supination are helpful in evaluating tendon fibers and can confirm if the insertion is intact. In this position, Mr. Schmitz explains how to evaluate tendon thickness and identify abnormalities such as fluid and calcifications.

Lastly, he explores the medial approach, which requires the forearm to be slightly flexed, with the scanner positioned in line with and over the distal humerus. From here, the brachial artery is an important landmark, and Mr. Schmitz uses it as an acoustic window to enhance visualization of the bicep tendon, including the insertion.

Mr. Schmitz is joined by your host Shelley Guenther. Together, they show you how to perform a thorough diagnostic examination of the distal biceps using high-resolution wireless ultrasound. You’ll learn a systematic protocol you can use for your next biceps tendon exam for a confident diagnosis. Don’t miss this webinar – watch now!