An anatomical study of the bicipital aponeurosis in embalmed and fresh frozen cadavers

Abstract

Objectives: The bicipital aponeurosis is a fascial expansion which arises from the distal tendon of biceps brachii muscle. It is an important structure for protecting the median nerve and brachial artery. The aim of this study was to analyze the morphometry and shape of the bicipital aponeurosis and its implications for the protection of the median nerve and brachial artery. Methods: Upper extremities of two fresh frozen and seven embalmed cadavers (five right, four left sides) were dissected. The ages of the cadavers varied between 60–86 years. The central length, superior width, central width, inferior width and the shape of bicipital aponeurosis were evaluated. All measurements were performed by using digital caliper. Results: The central length of the bicipital aponeurosis was measured 3.6±1.2 cm. The superior, central and inferior width of the bicipital aponeurosis were found 1.5±0.7 cm, 1.5±0.6 cm and 1.8±0.8 cm, respectively. Through the examination of upper extremities; two different shapes of bicipital aponeurosis were observed. In type I; the bicipital aponeurosis was fusiform in shape and observed in four upper extremities. In five extremities, it was found as quadrangular in shape and classified as type II. Conclusion: The morphometry and shape of bicipital aponeurosis have a clinical importance to protect the median nerve and brachial artery or to reduce compression of these neurovascular structures. A better understanding of bicipital aponeurosis morphometry is important in assessment of biomechanical properties of biceps brachii.

Keywords

• bicipital aponeurosis
• brachial artery
• median nerve
• morphometry

References

1. Congdon ED, Fish HS. The chief insertion of the bicipital aponeurosis is on the ulna; a study of collagenous bundle patterns of antebrachial fascia and bicipital aponeurosis. Anat Rec 1953;116:395–407.
2. Eames MHA, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am 2007;89:1044–9.
3. Landa J, Bhandari S, Strauss EJ, Walker PS, Meislin RJ. The effect of repair of the lacertus fibrosus on distal biceps tendon repairs: a biomechanical, functional, and anatomic study. Am J Sports Med 2009;37:120–3.
4. Blasi M, de la Fuente J, Martinoli C, Blasi J, Perez-Bellmunt A, Domingo T, Miguel-Perez M. Multidisciplinary approach to the persistent double distal tendon of the biceps brachii. Surg Radiol Anat 2014;36:17–24.
5. Dirim B, Brouha SS, Pretterklieber ML, Wolff KS, Frank A, Pathria MN, Chung CB. Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol 2008;191:248–55.
6. Vanhees M, van Riet RP. Reconstruction after distal biceps tendon rupture. Journal of Orthopaedics, Trauma and Rehabilitation 2012;16:2–8.
7. Snoeck O, Lefevre P, Sprio E, Beslay R, Feipel V, Rooze M, Van Sint Jan S. The lacertus fibrosus of the biceps brachii muscle: an anatomical study. Surg Radiol Anat 2014;36:713–9.
8. Bassett FHI, Spinner RJ, Schroeter TA. Brachial artery compression by the lacertus fibrosus. Clin Orthop Relat Res 1994;(307):110–6.

9. Caetano EB, Vieira LA, Almeida TA, Gonzales LAM, Bona JE, Simonatto TM. Bicipital aponeurosis. Anatomical study and clinical implications. Rev Bras Ortop 2018;53:75–81.
10. Joshi SD, Yogesh AS, Mittal PS, Joshi SS. Morphology of the bicipital aponeurosis: a cadaveric study. Folia Morphol (Warsz) 2014;73:79–83.
11. Martinelli P, Gabellini AS, Poppi M, Gallassi R, Pozzati E. Pronator syndrome due to thickened bicipital aponeurosis. J Neurol Neurosurg Psychiatry 1982;45:181–2.
12. Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am 2007;32:1225–9.
13. O’Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med 2007;35:1865–9.
14. Bosman HA, Fincher M, Saw N. Anatomic direct repair of chronic distal biceps brachii tendon rupture without interposition graft. J Shoulder Elbow Surg 2012;21:1342–7.
15. Conlin CE, Naderipour A, ElMaraghy A. Outcome of distal biceps tendon repair with and without concomitant bicipital aponeurosis repair. Orthop J Sports Med 2019;7:2325967119865500.
16. Fontana M, Trimarchi A, Colozza A. Lacertus fibrosus augmentation for distal biceps brachii rupture repair: surgical technique. Musculoskelet Surg 2016;100:85–8.