**3.4 Distal biceps tendon**

The distal biceps brachii tendon is located at the anterior elbow compartment, coursing through the antecubital fossa with its distal insertion at the radial bicipital tuberosity. Its superficial fibers form the lacertus fibrosis which course medially to form the distal portion of the tendon. Pathology of the distal biceps tendons is most common in people who perform heavy weightlifting, with increased risk in those who use anabolic steroids [12]. A distal biceps tendon tear results in retraction of the myotendinous junction, clinically known as a Popeye's sign or mass in the proximal arm. This is seen as complete discontinuity of the tendon fibers, best appreciated in axial and sagittal planes. In order to be able

**Figure 2.** *Proton density fat saturated coronal image of the elbow shows fluid signal at the insertion of the common extensor tendon consistent with a tendon tear.*

**21**

mation [15].

*Imaging of Tendons*

intensity [12].

**4. Hand/wrist**

**4.1 MRI protocol**

joints [13].

**4.2 Ultrasound examination technique**

carpal tunnel and Guyon's canal.

**4.3 De Quervain tenosynovitis**

tendons, thought to worsen symptoms.

*DOI: http://dx.doi.org/10.5772/intechopen.84521*

to visualize the retracted tendon and area of avulsion at its distal insertion the arm may be supine, flexed and abducted. If there is a partial tear present, then on magnetic resonance imaging there will be peritendinous increased T2 signal

For MR imaging of the hand the patient is placed in prone position, with the arm elevated above the head, also known as the "superman position". When specifically imaging the thumb, the latter should be fully extended and at the center of the scanner and foam pads may be used for fixation of the area of interest. Small surface or dedicated hand or wrist coils are important in order to obtain high quality images. Axial images with respect to the fingers are first obtained and these are then used to plan sagittal and coronal views. When imaging the thumbs, coronal and sagittal views should be tilted 90° to sesamoids at the level of the metacarpophalangeal joint (**Figure 3**) [13]. It is always important to include adjacent fingers within the field of view of the image for comparison [14]. Three-Tesla MRIs are preferred due to the high resolution and detail provided for these small anatomical regions. Standard sequences used to evaluate for hand tendinous or ligamentous injury are: coronal PD, axial T1, coronal T1, sagittal T1, axial T2 and sagittal T2W sequences. When evaluating the wrist, the wrist should be at the center of the scanner with dedicated surface coils as well. Coronal images should be oriented between the radial and styloid ulnar processes and sagittal images prescribed 90° to coronals. The axial images should include approximately 2–3 cm proximal to the radiocarpal joint and at least 1 cm distal to the carpometacarpal

US of the wrist and hand are usually tailored to an area of interest, according to patient symptoms. The wrist is separated into a dorsal and ventral compartment. The hand is placed in prone position and a transverse sweep allows evaluation of the 6-extensor compartments. The hand is later supinated, allowing evaluation of the

It is the second most common stenosing synovitis, presenting with pain and swelling at the styloid process region when moving the thumb or wrist.

Anatomically, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons are held within a fibro-osseous sheath called the extensor retinaculum. Repetitive trauma results in thickening of the tendons and retinaculum resulting in inflammation and edema. In some cases, a septum has been found between both

On US, the APL and EPB tendons are thickened at the level of the radial styloid with increased fluid within the first extensor compartment. A halo sign has been described, secondary to peritendinous subcutaneous edema. Doppler imaging should show increased vascularity secondary to hyperemia and inflamto visualize the retracted tendon and area of avulsion at its distal insertion the arm may be supine, flexed and abducted. If there is a partial tear present, then on magnetic resonance imaging there will be peritendinous increased T2 signal intensity [12].
