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