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Distal Biceps Tendon and Bicipitoradial Bursa Injection Other Names Distal Biceps Tendon Injection Bicipitoradial Bursa Injection Distal Biceps Tendon Aspiration Bicipitoradial Bursa Aspiration Background This page refers to Distal Biceps Tendon and Bicipitoradial Bursa Injection and Aspiration Key Points A high frequency, linear array transducer is recommended A posterior approach is recommended (described below) It is critical to identify the regional neurovascular structures during pre-procedure ultrasound Do not inject into the tendon Aspiration approach will vary based on size and location of the bursa, neurovascular structures Anatomy Cubital Fossa Contains the distal biceps tendon, bicipitoradial Bursa Contains Median Nerve, Radial Nerve Brachial Artery bifurcates into the Cubital Artery, Radial Artery Multiple superficial veins Distal Biceps Tendon Courses laterally and deep to insert on the radial tuberosity if the proximal radius Bicipitoradial Bursa Located between the distal biceps tendon anteriorly, radial tuberosity posteriorly [2] Purpose is to decrease friction between distal tendon, proximal radius during pronation/ supination Palpation vs Ultrasound Guidance To date, there are no studies comparing ultrasound-guided and palpation-guided approaches Because of the deep location, proximity to important neurovascular structures, imaging guidance is recommended Indications Contraindications Absolute Tendon tear or rupture Anaphylaxis to injectates Overlying cellulitis, skin lesion or systemic infection Relative Can be treated with less invasive means Hyperglycemia or poorly controlled diabetes Lack of symptom improvement with previous injection Procedure Equipment Sterile including chloraprep, chlorhexadine, iodine Ultrasound with sterile probe cover Gloves Needle: typically 21-25 gauge, 1.5 inch Syringe: 5-10 mL Gauze Ethyl Chloride Bandage Injectate Local anesthetic Corticosteroid/ injectate Ultrasound Findings Transducer: High Frequency, Linear Identify Distal biceps tendon Proximal neurovscular structures View Common ultrasound findings for tendon: Typical for tendinosis (hypoechogenicity, focal thickening, calcification, neovascularity, etc)

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