Hyperechoic lateral part of biceps muscle.

[Xue Heng]

Hi, Steve.
This case was a 70-year-old female, without any upper arm symptoms.
The lateral part of biceps muscle was hyperechoic with no reduced volume.
I wonder why this muscle could be that hyperechoic. Thank you, Steve, for your answer eveytime.

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[Xue Heng]

This was the viedo.

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[Stephen Bird]

Hi Xue,

Great images.

What brand is that machine?

The lateral part of the biceps muscle bellies is the long head component.

There are a few options.

I know how good you are so it is not going to be anisotropy in your hands. The long and short head bellies can be really anisotropic with one going white while the other goes black really dramatically and then with a small adjustment of transducer angle it reverses. This is especially apparent in younger fit people. But this is not the case in your example.

The answer I think is an old long head of biceps tendon origin rupture. This may have happened ages ago. The vinculum will likely be intact and hence there is not a “popeye” muscle deformity. If you look on the bicipital groove you may see a tendon, however when you look over the humeral head in the rotator cuff interval it will be absent.
The atrophy in your case is typical of this type of old injury.
The patient demographic also supports this diagnosis. So does the lack of current symptoms. The patient will have some relative supination strength compared to the other side, but this might not be apparent to the patient. Elbow flexion strength will be preserved as this is provided by the healthy short head of biceps component.

Other options for this appearance on ultrasound which I think are not the case in this example are:

DOMS overuse injury to the long head muscle belly

Isolated denervation from a Parsonage Turner (Neuralgic Amyotrophy) event.

But I think in your case it is a chronic long head of biceps rupture from the superior labrum / glenoid with preservation of the vinculum.

I always love your work Xue,

Steve

[Xue Heng]

Thank you, Steve. For your timely and detailed answer.
The machine is SuperSonic from France, famous for its SWE function.
I also think biceps tendon origin rupture caused the hyperechoic change of the muscle.
Scanning the LHBT at rotator cuff interval will prove this.
Thank you!

[Stephen Bird]

Yes, the images are nice.

I think that company has some interesting technology that is a little different from other machines.

I think we have agreed on the answer for the isolated muscle atrophy.

Steve

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