is musculoskeletal ultrasound a reliable tool to …...ix curso terico-pr ctico de ecograa...

IX Curso Teorico-Practico de Ecografia Musculoesqueletica

Donostia – San Sebastian, 4 a 6 de Octubre de 2017

Is musculoskeletal ultrasound a reliable tool to measure the morphometric parameters of the distal biceps brachii attachment? - ELECTRONIC POSTER

Leonardo di ser Piero da Vinci 1452 – 1519Leonardo da vinci Anatomist. Clayton and Philo; 2014

Background

Testut et al; 1944

DBBT: distal biceps brachii tendonEBA: external bicipital aponeurosis

EBADBBT EBA DBBT

Blasi et al; 2014LF = EBALH+SH = DBBT

DBBT

DBBT

Background

Pappas et al; 2002

IBADBBT

IBA: internal bicipital aponeurosis

Background

Questions:

• Is it possible to reproduce IBA, DBBT and EBA measurements by US?

• Is it possible to quantify thevariability in IBA, DBBT and EBA morphometric parameters?

Andries van Wesel 1514 - 1564

Background

Materials and methodsCadaver elbows were obtained from the body donorservice of the MHSC Bellvitge, “Universitat de Barcelona”.

1. 50 cryopreserved cadaver body donor elbows weredissected to perform a morphometric analysis (length,width and thickness) of the IBA, DBBT and EBA.

2. An US systematic technique was designed.3. The US systematic technique was validated by

examining and measuring 11 cryopreserved cadaverbody donor elbows and then correlating themeasurements with those obtained by posteriordissection.

US systematic technique:• 1 SHORT AXIS - LONG AXIS• 2 SHORT AXIS - LONG AXIS

Materials and methods1 2

Testut et al; 1944

Figure 1. Gross anatomy (top) and US (bottom) axial sections of the elbow. IBA: internal bicipital aponeurosis, EBA: external bicipital aponeurosis, DBBT: distal biceps brachii tendon, MTJ: myotendinous junction, Br. Art: braquial artery, Br. Art*: braquial artery division.

PROXIMAL DISTAL

IBA

EBA DBBT

Br. Art

Br. Art

Results

Results

IBA

EBA

DBBT

IBA DBBT EBAWidth 39,73 mm

(SD 9,96) 8,36 mm (SD 1,86)

10,95 mm (SD 6,00)

Thickness 0,76 mm (SD 0,24)

2,73 mm (SD 0,69)

0,83 mm(SD 0,31)

US-DISSECTION Goodness of fit

-Very good- R2= 0,96

(US)

Discussion

Snoeck et al; 2014

Gross anatomy previous published data

N = 50 DBBT EBAWidth 8,36 mm

(SD 1,86)10,95 mm (SD 6,00)

Thickness 2,73 mm (SD 0,69)

0,83 mm(SD 0,31)

Gross anatomy results obtained in the present study

Snoeck et al; 2014

Discussion

Konschake et al; 2017

Deep fascia???

EBA??? DBBT???

Deep fascia???

IBA???

• The highest variability observed was in the morphometricparameters related to the external bicipital aponeurosis.

• The US systematic technique hereby proposed achieves avery good correlation with posterior gross anatomydissection morphometric parameters and image.

To take home… • The distal biceps brachiiattachment is composed of threeconstant structures: the internalbicipital aponeurosis, the distalbiceps brachii tendon and theexternal bicipital aponeurosis.

• When the technique is correctlylearned, it could be useful in thestudy of distal biceps brachiiattachment in a clinical setting.

Bibliography1. Blasi M, de la Fuente J, Martinoli C, Blasi J, Pérez-Bellmunt A, Domingo T,

Miguel-Pérez M. Multidisciplinary approach to the persistent double distaltendon of the biceps brachii. Surg Radiol Anat. 2014 Jan;36(1):17-24.

2. Konschake M, Stofferin H, Moriggl B. Ultrasound visualization of anunderestimated structure: the bicipital aponeurosis. Surg Radiol Anat. 2017Jun 8.

3. Pappas GP, Asakawa DS, Delp SL, Zajac FE, Drace JE. Nonuniform shorteningin the biceps brachii during elbow flexion. J Appl Physiol (1985). 2002Jun;92(6):2381-9. PubMed PMID: 12015351.

4. Snoeck O, Lefèvre P, Sprio E, Beslay R, Feipel V, Rooze M, Van Sint Jan S. Thelacertus fibrosus of the biceps brachii muscle: an anatomical study. SurgRadiol Anat. 2014 Sep;36(7):713-9.

5. Testut L, Jacob O, Dupret S. Tratado de Anatomía Topográfica conaplicaciones medicoquirúrgicas. 6th ed. Barcelona - Buenos Aires: SalvatEditores S.A.; 1944.

Thank you

http://ecografiamusculoesqueleticass.com/