Sonographically guided distal biceps tendon injections: techniques and validation

The primary purpose of this investigation was to describe and validate sonographically guided techniques for distal biceps peritendinous/intratendinous injections using a cadaveric model.

A single experienced operator completed 18 sonographically guided distal biceps peritendinous injections and 15 sonographically guided distal biceps intratendinous injections in 18 unembalmed cadaveric elbow specimens (11 male and 7 female; age, 53-100 years; body mass index, 19.4-42.2 kg/m(2)). Four different peritendinous approaches were used to inject 3 mL of diluted yellow latex: (1) anterior/superficial, (2) posterior/superficial, (3) posterior/deep/short-axis (to the distal biceps tendon), and (4) posterior/deep/long-axis (to the distal biceps tendon). Three different intratendinous approaches were used to inject 1 mL of diluted blue latex: (1) anterior, (2) anterior/pronator window, and (3) posterior. The feasibility of all 7 injections was assessed by the operator in all specimens, and execution difficulty was recorded after each injection. Specimens were subsequently dissected to assess injectate placement.

All 18 peritendinous distal biceps tendon injections accurately placed latex around the tendon without injecting into the tendon proper. All posterior/superficial peritendinous injections delivered injectate to the ulnar side of the tendon. All posterior/deep peritendinous injections delivered injectate to the radial side of the tendon, with the long-axis approach being technically easier than the short-axis approach. Anterior/superficial peritendinous injections delivered injectate predominantly to the anterior side of the tendon and resulted in 1 brachial artery injury. All but 1 of 15 distal biceps intratendinous injections (93%) accurately placed injectate into the tendon proper, with 1 of 5 anterior injections delivering injectate primarily deep to the paratenon. The posterior intratendinous approach was technically the easiest. No intratendinous injection resulted in neurovascular injury.

Sonographically guided distal biceps peritendinous/intratendinous injections are feasible and therefore may play a role in the management of patients presenting with distal biceps tendinopathy/bursopathy.