**3. Elbow**

*Tendons*

**18**

novitis [7].

**Figure 1.**

in the dependent side of the long head of the biceps tendon sheath, as the tendon sheath normally communicates with the glenohumeral joint. High signal round structures found lateral to the tendon within the bicipital groove represent the anterior circumflex humeral artery/vein and should not be confused with tenosy-

*Magnetic resonance arthrogram T1 fat saturated coronal oblique image shows a full thickness tear of the* 

*supraspinatus tendon with contrast leaking from the joint capsule into the subdeltoid space.*

The long head of biceps brachii tendon should be found within the intertubercular groove upon sonographic evaluation of the shoulder. The tendon fibers should be seen without tears, heterogeneity or thickening. The normal tendon will appear hyperechoic; however, because the tendon courses deep, it may appear artifactually hypoechoic due to anisotropy [8]. Adjusting the transducer to aim the sound beam

The proximal aspect of the tendon may be affected by impingement in the same ways as the supraspinatus tendon because of its similar location and course beneath the supraspinatus tendon. Tears associated with impingement usually occur proximal to the bicipital groove and are usually seen in the older population. Acute tears unrelated to impingement are commonly secondary to a traumatic injury in young individuals, and usually occur distally in the tendon, near the musculotendinous junction [7]. When a full-thickness tear occurs, axial MRI images of the shoulder may show an empty bicipital groove, without evidence of the oval, low signal long head of the biceps tendon. An empty bicipital groove may also indicate tendon dislocation, which is also associated with disruption of the transverse humeral ligament that holds the biceps tendon in place. In this case, the low signal round tendon is seen medial to the bicipital groove, either deep or superficial to the subscapularis

perpendicular to the tendon fibers can eliminate this artifact.

tendon, which usually also tears as well.
