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Distal Musculotendinous T Junction Injuries of the Biceps Femoris: An MRI Case Review.

ABSTRACT: Injury to the distal musculotendinous T junction (DMTJ) of the biceps femoris is a distinct clinical entity that behaves differently from other hamstring injuries due to its complex, multicomponent anatomy and dual innervation. Injury in this region demonstrates a particularly high rate of recurrence, even with prolonged rehabilitation times.To describe the anatomy of the DMTJ of the biceps femoris and analyze the injury patterns seen on magnetic resonance imaging (MRI) to aid prognosis and rehabilitation and minimize the risk of recurrence.Cross-sectional study; Level of evidence, 3.Acute injury to the DMTJ of the biceps femoris was identified in 106 MRI examinations from 55 patients at a single institution. Each injury was classified as involving the long head, the short head, or both components of the DMTJ, with each component individually graded. Injuries were classified as recurrent if there was a previous MRI demonstrating an acute injury to the DMTJ or if there was scarring present at the site of an acute injury.Of the 106 acute injuries to the DMTJ of the biceps femoris, isolated injury to the long head component was the most common (51%), with both components involved in [round 42.5% to 43%] of cases. Isolated injury to the short head component accounted for 7% of cases. The recurrence rate for reinjury to the DMTJ was 54% in this series. The date of prior injury was known in 45 of 57 recurrent cases, with 34 of these reoccurring within 3 months (76%) and 40 reoccurring within 12 months (89%). The recurrent injury was of a higher grade than the prior injury in 22 of 44 instances (50%), the same grade in 16 instances (36%), and a lower grade in 6 instances (14%). Thus, 86% of recurrent injuries were of the same or higher grade than prior injury.These results suggest that high-risk muscle injuries, such as that to the DMTJ of the biceps femoris, should be evaluated using MRI to determine the structural components involved and to assess the extent and severity of injury.

SUBMITTER: Entwisle T

PROVIDER: S-EPMC5524253 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Project description:Iberian ham production includes both purebred (IB) and Duroc-crossbred (IBxDU) Iberian pigs, which show important differences in meat quality and production traits, such as muscle growth and fatness. This experiment was conducted to investigate gene expression differences, transcriptional regulation and genetic polymorphisms that could be associated with the observed phenotypic differences between IB and IBxDU pigs. Nine IB and 10 IBxDU pigs were slaughtered at birth. Morphometric measures and blood samples were obtained and samples from Biceps femoris muscle were employed for compositional and transcriptome analysis by RNA-Seq technology. Phenotypic differences were evident at this early age, including greater body size and weight in IBxDU and greater Biceps femoris intramuscular fat and plasma cholesterol content in IB newborns. We detected 150 differentially expressed genes between IB and IBxDU neonates (p < 0.01 and Fold-Change > 1. 5). Several were related to adipose and muscle tissues development (DLK1, FGF21 or UBC). The functional interpretation of the transcriptomic differences revealed enrichment of functions and pathways related to lipid metabolism in IB and to cellular and muscle growth in IBxDU. Protein catabolism, cholesterol biosynthesis and immune system were functions enriched in both genotypes. We identified transcription factors potentially affecting the observed gene expression differences. Some of them have known functions on adipogenesis (CEBPA, EGRs), lipid metabolism (PPARGC1B) and myogenesis (FOXOs, MEF2D, MYOD1), which suggest a key role in the meat quality differences existing between IB and IBxDU hams. We also identified several polymorphisms showing differential segregation between IB and IBxDU pigs. Among them, non-synonymous variants were detected in several transcription factors as PPARGC1B gene, which could be associated to altered gene function. Taken together, these results provide information about candidate genes, metabolic pathways and genetic polymorphisms potentially involved in phenotypic differences between IB and IBxDU associated to meat quality and production traits.

Project description:IntroductionThe simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern.Case presentationA 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a 'pop' on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later.ConclusionOverall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single-incision endobutton technique, which represents a valid option in managing this difficult problem.

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Distal Musculotendinous T Junction Injuries of the Biceps Femoris: An MRI Case Review.

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