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Larticulation du coude
A Aydinlioglu; FN Gumrukcuoglu; N Koyun. The prevalence of supracondyloid process in the living: a radiographic study
West Indian Med. L.2010; 59(5)
Les muscles
Brachialis
Epitrochlens
be important in stabilizing the tendons distally. The superficial layer originated from the anterior radial aspect of the long
head of the biceps just proximal to the commencement of the
distal biceps tendon. This superficial layer macroscopically
T H E J O U R N A L O Fwas
B Othe
N Ethickest
& J Olayer
I N T in
S UallRspecimens,
G E R Y J Band
J S .itOpassed
RG
I S T A L B I C E P S TE N D O N A N A T O MY :
in aDdistal
direction
VOand
L U Mulnar
E 89-A
N Uanterior
M B E R to
5 the
Mmusculotendinous
A Y 2007
AjuncC A D A VE R I C S T U D Y
tion of the short head. In some specimens, a rudimentary
middle layer, which acted as a mesentery, was present. It was
the only layer to attach to the short head. This middle layer
passed in an ulnar direction to merge anteriorly with the
su- the elbow extended, and between the proximal part of
with
perficial layer. The deep layer originated from the deep radial
thebi-radius and the biceps tendons during pronation of the
side of the musculotendinous area of the long head of the
Fig. 3
ceps. This layer passed in an ulnar direction deep to the
tenforearm.
Cross section of the two tendons (the short head [SH] and the long
don of the short head to merge with the other two layers.
These three layers merged and continued distally, super- The insertion of the long head was at a point farthest
head [LH]). The three layers of the aponeurosis stabilize the tendon of
the short head.
ficial to the ulnar flexor muscles of the forearm. Thereaway
were from the rotation of the radius, potentially providing
1048
Lacertus Fibrosus
Fig. 4
Discussion
e demonstrated that, in most individuals, the biceps
muscles are two independent muscle bellies of the two
heads, with two separate tendon areas. The remaining individuals had several interdigitations between both muscle bellies
and again two easily defined tendons. No biomechanical or
histological investigations were performed, and this is a potential limitation of the study.
The distinct pattern found in the majority of patients
was described recently in a case report4. The authors reported
The line of the humeral shaft is demonstrated (LH = long head and
SH = short head).
Zone 3: Postaponeurosis
The two tendons continued distal to the aponeurosis and inserted into the proximal part of the radius. In both groups, the
tendon of the long head passed deep to the tendon of the short
head to insert more proximally. The insertion of the tendon of
the long head was oval in shape, occupying most of the radial
tuberosity. The tendon of the short head curved anterior to
the tendon of the long head, to insert in a fan-like fashion into
the distal portion of the radial tuberosity, and extended distal
to it (Fig. 5). The attachments of the two distal tendons were
surrounded by the bicipitoradial bursa (Fig. 6). This bursa
completely encircled the distal tendons in all specimens. The
bursa could be easily distended by injection of 7 mL of saline
solution or latex on its deep radial side. The bursal membrane
continued around the ulnar side of the tendons, where it was
adherent to the tendon and would not distend. The bursa was
attached proximally to the biceps tendon on the radial aspect.
From this point, it draped down over the tendons, adhering to
both tendons on the ulnar aspect. The bursa was attached
along the proximal deep edge of the tendon of the long head
to create a teardrop shape. Thus, the bursa lay between the
groove in the brachialis muscle and the distal biceps tendons
Fig. 8
Dehors
Bas
v. basilique
v. cphalique
supination
pronation
Basset, Nunley. Compression of the musculocutaneous nerve at the elbow. JBJS Am 1982;
64A:1050-2.
Davidson, Basset, Nunley. Musculocutaneous nerve entrapment revisited. J Shoulder Elbow
1998; 7:250-5.
n. mdian et a. brachiale
Gouttire bicipitale interne
A. brachiale se divise en a. radiale et a. ulnaire qui
donne rapidement la. interosseuse commune
nerf mdian chemine sous trois zones de compression
potentielles
Pronator teres
Deux chefs (picondylien
mdial et ulnaire)
Nombreuses variations (nerf
mdian dessus-dessousentre les deux chefs)
Deux chefs
Zone de naissance du nerf
interosseux antrieur
n. radial
n. radial
Le tunnel radial
Dfini par Roles & Maudles
en 1972
Depuis linterligne
Jusqu lentre dans le
supinator
Dont le bord suprieur peut
tre fibreux (arcade de
Frhse)
Supinator
Enroul autour du radius
2 faisceaux
Pfd transversal
Sous la cavit sigmode du
cubitus
Face antero-ext col radius
Supf oblique
picondyle (fx moyen LLE)
Face ant. radius
Entre la br. post radiale
M
S
ARCADE
DE FROHSE
Epaississement fibreux de la partie
proximale du faisceau superficiel
Aspect normal musculaire ou
fibreux fin
Transformation fibreuse
Variante anatomique
Avec lge
Absente chez le Ftus
Plus frquente chez ladulte
Suite surmenage rptitif
Br
Sensitive
Br
Sensitive
Br
Br
Motrice
Motrice
Exercice possible
La section puis rinsertion du
tendon distal du biceps au coude
et les rapports anatomiques
Pourquoi en parler ?
Nombreuses
variations
Fig. 1
Two individual muscle bellies with an equal number of branches from the musculocutaneous
nerve.
The long head (LH) and short head (SH) showing the crescentic shape of the tendon of the long
head, which stabilizes and contains the tendon of the short head.
1227
Nombreuses
variations
Figure 2. The long- and short-head biceps tendon insertions are illustrated (A). The mean footprint area of the long head of the
tendon was 48 mm2 and of the short head of the tendon was 60 mm2. A cadaveric specimen (B) demonstrates the separation
between the short and long heads of the distal tendons (white arrow) with near complete rupture of the short head of the distal
tendon (black arrow).
lesced enough that precise calculation of the individual footprints was difficult and therefore thought to
be imprecise and was abandoned.
The lacertus fibrosus was examined and found to
originate from the proximal aspect of the short head
of the distal tendon (Fig. 1) in all 15 specimens.
Tendon Insertion
In all specimens, the biceps tendon insertion was
located along the extreme ulnar margin of the bicipital tuberosity (Fig. 3). The tendon is ribbon-shaped
just proximal to its insertion; however, as it approaches the tuberosity the tendon thickens in width
and length creating a true footprint on the tuberosity. The average distance from the articular margin
of the radial head to the start of the biceps tendon
insertion in all specimens was 23 mm (range, 18 27
mm); the average distance in the male specimens was
25 mm (range, 22 to 27 mm) and in the female specimens was 22 mm (range, 18 25 mm). The average
length of the biceps tendon insertion on the tuberosity
was 21 mm (range, 1725 mm) and the average width
was 7 mm (range, 6 10 mm). The average length and
Hypovascularisation tendon
distal
Discussion
The purpose of this anatomic project was to provide
quantitative data on the dimensions and area of the
biceps tendon insertion on the radius and to identify
local landmarks to assist with correct tendon orientation. The clinical importance of re-creating normal
distal biceps tendon orientation is unknown; how-
Poudel, PP; Bhattarai, C (2009). "Study on the supernumerary heads of biceps brachii muscle in Nepalese" Nepal Med
Coll J 11 (2): 9698.
Dirim, B; Brouha, SS; Pretterklieber, ML; Wolff, KS; Frank, A; Pathria, MN; Chung, CB (2008). "Terminal Bifurcation of the
Biceps Brachii Muscle and Tendon: Anatomic Considerations and Clinical Implications". American Journal of
Roentgenology 191 (6): W248-W255
Fogg QA, et al. The distal biceps brachii tendon anatomy revisited from a surgical perspective. Clin Anat 2009;22;346-51
Insertion
distale
Mazzocca et al 125
Distance from
radial head to
BT (mm)
BT width (mm)
BT length (mm)
Diameter of radius
distal to BT (mm)
Width of radius at
BT (mm)
Styloid angle ()
Radial head
diameter (mm)
Radial neck-shaft
angle ()
Radial length (mm)
Mean ! SD
Minimum
25 ! 3
15 ! 2
22 ! 3
19
10
16
30
19
30
17 ! 2
13
22
17 ! 2
123 ! 10
12
98
23
142
Maximum
23 ! 2
18
28
7!3
24 ! 2
0
20
14
27
Figure 4 This Faxitron image shows a proximal radius with a bicipital tuberosity that lies in more than 90! pronation from anterior.
When this anatomic variation is found intraoperatively, the tendon
insertion cannot be restored anatomically with current single-incision techniques.
al 125
VO L U M E 89-A N U M B E R 5 M A Y 2007
A C A D A VE R I C S T U D Y
Insertion distale
Fig. 5
Insertion footprint of the long head (LH) and the short head (SH) into the proximal part of the
radius.
Figure 4 This F
ital tuberosity t
When this ana
insertion canno
sion techniques
Figure 2. The long- and short-head biceps tendon insertions are illustrated (A). The mean footprint area of the long head of the
tendon was 48 mm2 and of the short head of the tendon was 60 mm2. A cadaveric specimen (B) demonstrates the separation
The
bice
between the short and long heads of the distal tendons (white arrow) with near complete rupture of the short head of
the distal
a clean man
tendon (black arrow).
lesced enough that precise calculation of the individual footprints was difficult and therefore thought to
be impreciseFig.and
was abandoned.
6
The bicipitoradial
bursa was
injected with
latex.
The lacertus
fibrosus
examined
and found to
originate from the proximal aspect of the short head
of the distal tendon (Fig. 1) in all 15 specimens.
tion. This m
makeup6 o
width of the biceps insertion in the male specimens
10
Intr
ment.
were 22 mm and 8 mm, respectively, and in the
of c
female specimens were 20 mm and 7the
mm,task
respecten
tively. The average area of the biceps original
tendon inser2
tion (footprint) in all specimens was 108operative
mm (range, te
2
81135 mm ). The average area in the
male and
of Boyd
and
2
2
9,12,13,18,20
female specimens was 112 mm and 104
mm , reTendon Insertion
4,21
spectively.
anchors,
In all specimens, the biceps tendon insertion was
In 10 specimens the exact dimensions and area of
ence screw
located along the extreme ulnar margin of the bicipthe short- and long-head tendon insertions could be
study onhas
ital tuberosity (Fig. 3). The tendon is ribbon-shaped
calculated. The short-head tendon insertion
the
Figure 3 however,
This diagram
biceps brachii
tendon
insertion.
just proximal to its insertion;
as itshows
ap- thebicipital
in
tuberosity averaged 12 mm in followed
length, 7 mm
envelops
bicipital
tuberosity
extending
ul2
proaches the tuberosityThe
thetendon
tendon footprint
thickens in
width the in
width and 60 mm in area. The long-head
Thetendon
2-inc
nar
to
the
apex
towards
the
top
of
the
diagram.
and length creating a true footprint on the tuberinsertion on the bicipital tuberosity averaged
mm in
and 9Anders
2
osity. The average distance from the articular margin
length, 7 mm in width and 48 mm in area.
Athwal GS, et al. The distal biceps tendon: Footprint and relevant clinical
anatomy. J Hand Surg Am 2007;32:1225-9
Rapports vasculonerveux
En S italique (brachiale et
antbrachiale)
Transversale (assistance
endoscopique)
En L invers