PMC8720479_01
Preoperative MR neurogram of the right elbow. Axial T1 MR images (a) demonstrating a thin fat pad (arrow) between the biceps aponeurosis and underlying neurovascular bundle. (b) T1 coronal MR imaging demonstrates three distinct tendons forming the biceps aponeurosis (three arrows). (c) T2 axial demonstrates subtle enhancement of the median nerve (star).
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F1
MR neurogram of the median nerve at the right elbow demonstrates a small accessory band of the biceps tendon that begins at the distal biceps muscle and travels for a short length next to the neurovascular bundle [Figure 1].
Operative approach. Two incisions were planned, one rostral to the elbow crease and medially oriented and the second distal to the elbow. This avoids an incision crossing the elbow crease. The intervening skin is lax and easy to retract so that there was no compromise to visibility.
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F2
One incision was made medial to the biceps in the arm and another in the ventral forearm [Figure 2].
Intraoperative view of accessory biceps aponeurosis (arrow) coursing lateral to medial overlaying the median nerve (blue loop) pre decompression (a) and post decompression (b).
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F3
A tight accessory limb of the bicipital aponeurosis was identified overlaying the median nerve and inserting into the fascia of the pronator teres muscle [Figure 3].