Bicipitoradial Bursa

Paratendinous bursae (e.g., the retrocalcaneal bursa at the heel, the deep infrapatellar bursa at the knee, and the bicipitoradial bursa at the elbow) primarily act as shock absorbers by reacting to increased compression and frictional forces exerted by the overlying tendons (Gibbon and Wakefield 1999). In most cases, intrabursal fluid or synovial hypertrophy denote an inflammatory process that is mechanical in origin and occurs in proximity to the preinsertional portion of the tendon (Fig. 3.42d,e). If mild, fluid does not have clinical importance and reflects irritation due to local overload and work... 

Several synovial bursae around the elbow joint lessen friction between bones and the overlying skin and soft-tissue structures. The most important are the olecranon bursa and the bidpitoradial bursa. The olecranon bursa is a large subcutaneous bursa which intervenes between the skin and the olecranon process over the posterior aspect of the elbow. The bidpitoradial bursa (cubital bursa) lies deep in the anterior compartment of the elbow, between the distal biceps tendon and the radial tuberosity, to reduce friction between, especially during pronation of the forearm (Skaf et al. 1999). In fact, the radial tuberosity rotates posteriorly during pronation and wraps the tendon around the radial cortex. During this movement, the bursa is tracked between the tendon and the bone (Fig. 8.8). When distended by fluid, the bicipitoradial bursa may surround the biceps tendon completely and may cause a mass effect on the adjacent branches of the radial nerve. 

Fig. 8.8a-c. Bicipitoradial bursa. a,b Schematic drawings illustrate the position of the bicipitoradial bursa (asterisks) relative to the distal biceps tendon (T) during a supination and b pronation. In pronation, the long axis of the radius (R) and the radial tuberosity (star) rotate compressing the bursa between the distal biceps tendon (T) and the bone. U, ulna. (Drawings modified by Skaf et al. 1999.) c Skeletal model showing the relationship of the bicipitoradial bursa (asterisk) with the distal biceps tendon (T) in full pronation. Note the posterior and lateral position of the radial tuberosity (star) onto which the biceps tendon inserts... 

When the bicipitoradial bursa is only mildly distended, US may have difficulty in distinguishing it from the adjacent distal biceps tendon that appears hypoechoic due to anisotropy (Miller and Adler... 

Fig. 8.32a,b. Bicipitoradial bursitis, a Longitudinal and b transverse 12-5 MHz US images over the antecubital fossa at level distal to the joint line show fluid distension of the bicipitoradial bursa (asterisks) which almost completely surrounds the adjacent normal distal biceps tendon (T), thus mimicking a tenosynovitis process... 

Fig. 8.33a-d. Calcified bicipitoradial bursitis in a woman with chronic renal failure who presented with a palpable mass in the antecubital fossa and difficulties in pronation, a Photograph shows focal soft-tissue swelling (arrowheads) over the anterior proximal forearm, b Transverse and c longitudinal 12-5 MHz US images reveal extensive hyperechoic deposits (arrows) with faint posterior acoustic shadowing related to calcifications with the bicipitoradial bursa. The bursa exhibits thickened walls and the distal portion of the biceps tendon (T) is completely surrounded by calcifications, d Correlative lateral radiograph shows the bulk of calcifications (arrows) in the antecubital fossa... 

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