Distal biceps tendon large partial tear: Ultrasound, MRI, and surgical findings

The figures above show ultrasound and MRI images and surgical findings of a ype 2B injury (high-grade partial tear at the attachment) of the distal biceps brachii tendon (DBBT).
(A) In the long-axis view, a high-grade partial detachment (arrows) affecting more than 50 percent of the DBBT is seen adjacent to the radial tuberosity. The most superficial arrows show a hyperechogenic line that corresponds to the torn tendon interface. The defect percentage is calculated by considering tendon thinning, not the volume of anechoic fluid, as the fluid image can change from alterations in transducer pressure over the region.
(B) This is a short-axis view of panel A. The anechoic defect demonstrates that most tendon fibers are torn (arrows).
(C) The surgical findings correlate with the ultrasound images in panels A and B. The forceps point to the attachment of some remaining DBBT fibers to the radial tuberosity (RT).
(D) Elbow MRI, axial PD with FS-weighted sequence. An intra-tendinous hyperintense signal (thick arrow), similar to that of fluid, shows a tendon defect affecting more than 50 percent of the DBBT and therefore compatible with a high-grade partial detachment (DBBT tear type 2B).