What is the role of MRI in the workup of bicipital tendonitis?

Updated: Nov 21, 2018
  • Author: Britt A Durham, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Magnetic resonance imaging (MRI)

  • This imaging study can demonstrate the entire course of the long head of the biceps tendon. However, MRI is expensive and not cost effective as a routine imaging test for bicipital lesions. [16, 17] Buck et al attempted to correlate alterations in biceps tendon diameter and signal on MRIs to gross anatomy and histology with the use of cadaveric shoulder specimens. [17] Two independent readers assessed T1-weighted, T2-weighted fat-saturated, and proton density-weighted fat-saturated spin-echo sequences in a blinded fashion. The investigators found that MRI-based localization of degeneration correlated well with histologic findings, but although diameter changes were specific in diagnosing biceps tendinopathy, they were not sensitive. [17] In another study, Gaskin et al retrospectively evaluated medical records with prospective MRI diagnoses of tendinopathy and/or partial tears of the long head of the biceps tendon at the entrance of the bicipital groove, with surgical correlation within 4 months of the imaging. [16] Tears at this location are generally difficult to detect on MRI.One hundred percent (16 of 16) of patients demonstrated focal tendon intrasubstance signal abnormalities, whereas 50% showed focal tendon enlargement (8 of 16). Ninety-four percent (15 of 16) of the biceps partial tears received surgical treatment. Gaskin et al suggested that although focal partial tears of the biceps tendon may coexist with other causes of shoulder pain, they may also exist in isolation and can be treated surgically. [16]  

  • A review by Carr et al found that MRI can show changes in signal sequence or tears, however, MRI has a low sensitivity and frequently results in missed or misdiagnosed biceps pathology. [18]

  • MRI should be considered after unsuccessful rehabilitation and in cases of suspected rotator cuff injury or labral tear injury.

  • A prospective study by Rol et al analyzed cross-sectional imaging with MRI or CT arthrography data from 25 rotator cuff tear patients and reported that pre-operative imaging is not sufficient to make a diagnosis of long head of biceps tendinopathy. [19]

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