The Size of the Radial Tuberosity is Not Related to the Occurrence of Distal Biceps Tendon Ruptures: A Case-Control Study

Izaäk F. Kodde*, 1, 2, Michel P.J. van den Bekerom3, Paul G.H. Mulder4, Denise Eygendaal1
1 Department of Orthopedics, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
2 Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands
3 Department of Orthopedics, O.L.V.G. Hospital, Amsterdam, The Netherlands
4 Consulting Biostatistician, Amphia Academy, Amphia Hospital, Breda, The Netherlands

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© Kodde et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Academic Medical Center, Department of Orthopedics, Post-Box 22660, 1100 DD Amsterdam, The Netherlands; Tel: 0031614198331; Fax: 0031205669117; E-mail:



Hypertrophic changes at the radial tuberosity have traditionally been related to distal biceps tendon degeneration and rupture. From supination to pronation of the forearm, the space available for the distal biceps tendon between de lateral ulna and radial bicipital tuberosity (RBT) decreases by almost 50%. A hypertrophic change at the radial tuberosity further reduces this space with impingement of the distal biceps tendon as a result. The purpose of this study was to evaluate whether the size of the RBT plays a role in the pathophysiology of distal biceps tendon ruptures.

Materials and Methods:

Twenty-two consecutive patients with a surgically proven distal biceps tendon rupture were matched to controls, in a 1:1 ratio. The size of the RBT was expressed as a ratio of the maximum diameter of the radius at the RBT to the diameter of the diaphysis just distal to the RBT (RD ratio), measured on standard radiographs of the elbow. The RD ratio of patients and matched controls were compared.


The mean RD ratio in control group was 1.25 and not significantly different from the mean 1.30 in the group of patients with a distal biceps tendon rupture. Each 0.1 point increase in RD ratio results in an estimated 60% increase of the rupture odds, which was not significant either.


Based on the RD ratio on conventional radiographs of the elbow, there was no significant difference in RBT size between patients with a distal biceps tendon rupture and matched controls without biceps tendon pathology.

Keywords: Anatomy, distal biceps tendon, elbow, pathophysiology, radial bicipital tuberosity, rupture.