Clin Should Elbow.  2021 Jun;24(2):93-97. 10.5397/cise.2021.00010.

Distal biceps tendon injection

• Vis Jvd
• Janssen SJ
• Bleys RL
• Eygendaal D
• Bekerom MPvd
• Elbow Study Collaborative

• KMID: 2516554
• DOI: http://doi.org/10.5397/cise.2021.00010

Abstract

Background
Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon.
Methods
Seven upper limb specialists, two general orthopedic specialists and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye.
Results
In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral.
Conclusion
Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.

Keyword

Elbow; Partial biceps tendon tear; Bicipitoradial bursitis; Biceps tendinopathy; Injection therapy; Injection accuracy; Cadaveric study