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From the question on p 172


Complete left distal biceps brachii tendon rupture.

Imaging findings

The distal portion of the biceps tendon could not be visualised at its insertion site on the radial tuberosity on the ultrasonography (US) scan. There was increased echogenicity and heterogeneity of the biceps tendon proximal to the expected insertion of the tendon (fig 1). The sonographic appearance was felt to be highly suggestive of a full-thickness tear of the biceps tendon at its insertion. However, because the referring physician did not observe any local bruising and the patient had retained some strength of forearm supination, a partial-thickness tear considered to be the most likely on clinical grounds.

Figure 1

Ultrasonography image of the antecubital fossa. (A) Expected insertion site of biceps tendon onto radius. No normal tendon is seen in this location. (B) Retracted end of biceps tendon.

For further evaluation, MRI of the left elbow was performed. A complete tear of the distal biceps tendon was seen. The tendon was retracted approximately 4 cm from the expected insertion on the radial tuberosity and there was oedema and fluid surrounding the retracted biceps tendon (fig 2, 3).

Figure 2

Sagittal T2-weighted MRI scan of the elbow.

Figure 3

Axial T2-weighted MRI scan through the distal humerus.

Surgery confirmed the presence of a complete tendon rupture with retraction. A surgical repair was undertaken, and the patient had a good functional outcome on clinical follow-up. Standard surgical repair of the torn distal biceps …

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  • I-Test cases are designed as clinical teaching vignettes—they are not designed to be case reports. To protect anonymity of patients and clinicians involved, the authors of the I-Test have altered certain descriptive elements from the original case. Thus, the I-Test does not necessarily represent a specific clinical encounter.

  • Patient consent: Obtained.

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