Greater radial tuberosity size is associated with distal biceps tendon rupture: a quantitative 3-D CT case\u2013control study

Nick F J Hilgersom,Stein J Janssen,Myrthe Nagel,Izaäk F Kodde,Bertram The,Denise Eygendaal

doi:10.1007/s00167-021-06722-5

Nick F J Hilgersom, Stein J Janssen + Show 4 more

Open Access

https://doi.org/10.1007/s00167-021-06722-5

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Abstract

PurposeDuring pronation, the distal biceps tendon and radial tuberosity internally rotate into the radioulnar space, reducing the linear distance between the radius and ulna by approximately 50%. This leaves a small space for the distal biceps tendon to move in and could possibly cause mechanical impingement or rubbing of the distal biceps tendon. Hypertrophy of the radial tuberosity potentially increases the risk of mechanical impingement of the distal biceps tendon. The purpose of our study was to determine if radial tuberosity size is associated with rupturing of the distal biceps tendon.MethodsNine patients with a distal biceps tendon rupture who underwent CT were matched 1:2 to controls without distal biceps pathology. A quantitative 3-dimensional CT technique was used to calculate the following radial tuberosity characteristics: 1) volume in mm3, 2) surface area in mm2, 3) maximum height in mm and 4) location (distance in mm from the articular surface of the radial head).ResultsAnalysis of the 3-dimensional radial tuberosity CT-models showed larger radial tuberosity volume and maximum height in the distal biceps tendon rupture group compared to the control group. Mean radial tuberosity volume in the rupture-group was 705 mm3 (SD: 222 mm3) compared to 541 mm3 (SD: 184 mm3) in the control group (p = 0.033). Mean radial tuberosity maximum height in the rupture-group was 4.6 mm (SD: 0.9 mm) compared to 3.7 mm (SD: 1.1 mm) in the control group, respectively (p = 0.011). There was no statistically significant difference in radial tuberosity surface area (ns) and radial tuberosity location (ns).ConclusionRadial tuberosity volume and maximum height were significantly greater in patients with distal biceps tendon ruptures compared to matched controls without distal biceps tendon pathology. This supports the theory that hypertrophy of the radial tuberosity plays a role in developing distal biceps tendon pathology.Level of evidenceLevel III.

Highlights

Distal biceps tendon ruptures are more common than previously thought with an incidence of approximately 1.2–5.4 per 100,000 persons per year [8, 19]
Nine consecutive patients who routinely had a CT scan (0.75–1.00 mm slice thickness, 80 kV, 55–57 mAs) of their elbow performed after a subacute or chronic distal biceps tendon rupture and before operative re-fixation were identified at our institution between October 2015 and March 2018
No patients had to be excluded based on pre-existing elbow disease believed to affect proximal radius morphology

Summary

Introduction

Distal biceps tendon ruptures are more common than previously thought with an incidence of approximately 1.2–5.4 per 100,000 persons per year [8, 19]. The distal biceps tendon and radial tuberosity internally rotate towards the ulna, reducing the linear distance between the radius and ulna by approximately 45–48% [3, 11, 18, 22] and leaving little space (< 1 mm) for the biceps tendon to move [14]. This could possibly cause mechanical impingement of the distal biceps tendon.

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