Ultrasound of the Hand and Upper Extremity by Fowler John R. Rawool Nandkumar

Author:Fowler, John R.,Rawool, Nandkumar.
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2017-09-25T16:00:00+00:00

Fig. 11.1 Patient setup for the distal biceps anterior approach. The patient’s arm is placed on the examination table with the elbow extended and the forearm supinated.

♦ Landmarks

The following landmarks should be noted (Fig. 11.2):

• Medial epicondyle

• Brachial artery

• Distal biceps tendon

♦ Probe Positioning

Transverse, Short Axis

• The probe should be placed on the ventral aspect of the distal upper arm perpendicular to the long axis of the arm (Fig. 11.3).

• At this level, the biceps brachii is identified superficial to the brachialis (Fig. 11.4a).

• Keeping the probe perpendicular to the long axis of the arm, scanning proceeds distally until the biceps tendon is visualized lateral to the neurovascular bundle(Fig. 11.4b).

• The tendon is relatively hyperechoic with a fibrillar pattern.

• The identity of the biceps tendon is confirmed by using anisotropy. Changing the orientation of the transducer in the cranial-caudal dimension will cause the echogenicity of the tendon to transition from hyperechoic to hypoechoic.

• Scanning continues distally until the insertion of the biceps tendon on the radial tuberosity is identified. As the tendon dives deep to the insertion, taking an oblique course, the ultrasound beam is angled cranially to keep the tendon fiber long axis perpendicular to the ultrasound beam (Fig. 11.4c-f).

• The lacertus fibrosus (biceps aponeurosis) can be visualized as a thin hyperechoic band extending from the biceps tendon to the superficial fascia of the medial forearm (see Fig. 11.4b).

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