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Comparing Radial Tuberosity-Ulna Distance in Distal Biceps Rupture to Healthy Controls
Richard W McKinney, MD
1, David Wang, MD
1, David Okhuereigbe, BS
2, Patrick Schimoler, PhD
1; Peter Tang, MD
3(1)Allegheny Health Network, Pittsburgh, PA, (2)Drexel University School of Medicine, Philadelphia, PA, (3)Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA
Introduction: Distal biceps tendon ruptures are relatively rare injuries caused by excessive load during eccentric contraction of the biceps leading to catastrophic failure. Risk factors such as increasing BMI, smoking, male gender, and anabolic steroid use. Despite known risk factors and mechanism, the exact pathophysiology of these ruptures remains controversial. Two proposed etiologies include poor vascularity and impingement. Anatomic studies have shown the biceps tendon takes up as much as 85% of the space between the radial tuberosity and proximal ulna and that this space can narrow by as much as 50% through forearm rotation. The aim of this study is to compare the minimum distance between the radial tuberosity and the proximal ulna in patients with distal biceps rupture and healthy controls. We hypothesized that patients with distal biceps tendon rupture would have decreased space in this interval compared to healthy controls, supporting impingement as a cause.
Materials & Methods: Elbow MRIs of 30 patients with distal biceps tendon rupture and 30 patients with normal distal biceps were segmented into 3D models with rotational reference points using 3D Slicer. The models were rotated and the minimum distance between the radius and ulna at the level of the tuberosity was calculated using MatLab software.
Results: The mean distances were 3.76 mm (95% CI 3.13-4.38) and 3.86 mm (95% CI 3.29-4.43) in the rupture and non-rupture group, respectively. We found no statistical difference in the distances of the two groups (p = 0.805).
Conclusions:We found no significant difference in radial tuberosity-ulna distance in subjects sustaining distal biceps rupture versus those who did not
3D sectioning and reconstruction of MRIs allows for comprehensive and dynamic anatomical analysis of the elbow from standard static images
Additional research is needed to further explore the pathogenesis of distal biceps rupture
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