US Area of Interest The use of US to evaluate the distal biceps tendon is well described in the literature [21,29,30]. A study by de la Fuente et al [30] investigated the sensitivity of US in detecting injuries of the distal biceps brachii tendon. The authors compared US examinations with MRI and surgery and found a slight statistical advantage of US over MRI. However, US is at a disadvantage with regard to the detection of partial tearing and tendinopathy. Lynch et al [31] showed the accuracy of US in the diagnosis of complete distal biceps tendon rupture was inferior to MRI, 45.5% compared with 86.4%. The accuracy rate of US to detect partial tears of the biceps was the same as MRI at 66.7%. The sensitivity and specificity of US for the detection of biceps tendon tears were 62.5% and 20.0%, respectively, inferior to MRI at 76% and 50%. The authors concluded that MRI is a more accurate imaging modality at correctly identifying the type of distal biceps tendon tear, thus enabling the orthopedic surgeon to provide a more precise treatment plan. Deschrijver et al [32] conducted an extensive literature search and meta-analysis to assess the usefulness of clinical examination testing as well as the usefulness of US. They further investigated whether supplementary sonographic views/maneuvers (eg, posterior approach Cobra technique, lateral approach supinator view, and medial approach pronator view) added benefit to the standard US examination. Their conclusion was that US can be considered an alternative to MRI in the evaluation of the distal biceps tendon ruptures. In a recent study by Miller et al, it was shown that radiologists preferred the medial imaging approach. Furthermore, this particular imaging approach demonstrated substantial interreader agreement [33]. Triceps tendon ruptures are rare, and a handful of studies have shown that US can identify both complete and isolated partial tears of the triceps brachii tendon [34,35].
Acute Elbow and Forearm Pain. US Area of Interest The use of US to evaluate the distal biceps tendon is well described in the literature [21,29,30]. A study by de la Fuente et al [30] investigated the sensitivity of US in detecting injuries of the distal biceps brachii tendon. The authors compared US examinations with MRI and surgery and found a slight statistical advantage of US over MRI. However, US is at a disadvantage with regard to the detection of partial tearing and tendinopathy. Lynch et al [31] showed the accuracy of US in the diagnosis of complete distal biceps tendon rupture was inferior to MRI, 45.5% compared with 86.4%. The accuracy rate of US to detect partial tears of the biceps was the same as MRI at 66.7%. The sensitivity and specificity of US for the detection of biceps tendon tears were 62.5% and 20.0%, respectively, inferior to MRI at 76% and 50%. The authors concluded that MRI is a more accurate imaging modality at correctly identifying the type of distal biceps tendon tear, thus enabling the orthopedic surgeon to provide a more precise treatment plan. Deschrijver et al [32] conducted an extensive literature search and meta-analysis to assess the usefulness of clinical examination testing as well as the usefulness of US. They further investigated whether supplementary sonographic views/maneuvers (eg, posterior approach Cobra technique, lateral approach supinator view, and medial approach pronator view) added benefit to the standard US examination. Their conclusion was that US can be considered an alternative to MRI in the evaluation of the distal biceps tendon ruptures. In a recent study by Miller et al, it was shown that radiologists preferred the medial imaging approach. Furthermore, this particular imaging approach demonstrated substantial interreader agreement [33]. Triceps tendon ruptures are rare, and a handful of studies have shown that US can identify both complete and isolated partial tears of the triceps brachii tendon [34,35].