From the Guidelines
The recommended initial imaging for a bicep tendon partial tear is an MRI without IV contrast, as it has improved sensitivity for the detection of partial tears of the biceps and triceps tendons. This recommendation is based on the most recent and highest quality study available, which suggests that MRI is particularly useful in the assessment of biceps tears 1. The use of noncontrast MRI in the assessment for ligamentous and tendinous injury has been evaluated in several studies, and it has been shown to have good interobserver agreement in the assessment of lateral collateral complex injuries and the worst interobserver reliability for the UCL 1.
When it comes to the assessment of biceps tears, MRI has been shown to have an improved sensitivity for the detection of partial tears of the biceps and triceps tendons 1. In a study of 77 patients, Nicolay et al showed that partial rupture of the long head of the biceps with an intact short head of the biceps was the most common injury, and that traumatic ruptures had a significantly higher association with ruptures of the short head of the biceps tendon 1.
While ultrasound is also a useful imaging modality for the detection of biceps tendon abnormalities, with reports showing 95% sensitivity, 71% specificity, and 91% accuracy for the diagnosis of complete versus partial distal biceps tendon tears 1, MRI is preferred due to its superior soft tissue contrast and ability to better characterize the extent of the tear, associated injuries, and help with surgical planning if necessary.
Some key points to consider when using MRI for the assessment of bicep tendon partial tears include:
- The use of noncontrast MRI is sufficient for the assessment of biceps tears, and IV contrast is not necessary 1
- The FABS (flexion-abduction-supination) MRI view can be useful in the assessment of distal biceps tendon pathology, particularly in challenging cases of high-grade partial versus complete tendon tears 1
- MRI is also useful in the assessment of rare triceps tears, and can help to identify the extent of the tear and associated injuries 1
From the Research
Initial Imaging for Bicep Tendon Partial Tear
The recommended initial imaging for a bicep tendon partial tear can vary depending on the location and severity of the tear.
- For proximal bicep tendon lesions, MR imaging is preferred over ultrasound due to its ability to assess lesions hidden under the acromion 2.
- For distal biceps tendon tears, both MRI and ultrasonography can be used, with MRI being more accurate in diagnosing complete and partial tears 3.
- A study from 2008 suggests that initial investigations for partial distal biceps tendon tears should include plain x-ray and a magnetic resonance scan 4.
- Another study from 2022 recommends using a magnetic resonance scan with the arm positioned in elbow flexion, shoulder abduction, and forearm supination (FABS MR) to confirm the diagnosis of a partial tear of the distal biceps tendon 5.
- Ultrasonography can be used as an initial imaging test for suspected abnormalities of the rotator cuff or biceps tendon, with a high sensitivity and specificity in detecting tears of the rotator cuff 6.
Comparison of Imaging Modalities
- MRI has substantial advantages over ultrasound in diagnosing biceps tendon lesions, especially in the proximal part 2.
- MRI is more accurate than ultrasonography in diagnosing complete and partial distal biceps tendon tears, with an overall accuracy rate of 80.6% compared to 51.6% for ultrasonography 3.
- Ultrasonography is more cost-effective than MRI, but may not be as accurate in diagnosing certain types of tears 3.