Imaging for Biceps Tendinitis Confirmation

Primary Imaging Recommendation

The American College of Radiology recommends MRI without contrast and ultrasound as equally appropriate imaging studies for confirming biceps tendinitis, with both rated 9/9 for sensitivity and specificity 1, 2
The choice between MRI and ultrasound depends on local expertise and availability, with both considered equivalent for evaluating suspected biceps tenosynovitis or tendinitis 1, 2

MRI demonstrates soft tissue abnormalities in the biceps tendon with high accuracy, showing tendinosis, partial tears, and tenosynovitis clearly 2
MRI has superior accuracy (86.4%) compared to ultrasound (45.5%) for biceps tendon tears specifically 3
MRI sensitivity and specificity for biceps tendon injury are reported at 92.4% and 100% respectively for complete ruptures, and 59.1% and 100% for partial tears 4
Ultrasound performs similar to or slightly better than MRI for complete versus partial distal biceps tendon tears, with 95% sensitivity, 71% specificity, and 91% accuracy 4
Ultrasound can be performed with concurrent therapeutic injection of anesthetic and/or corticosteroid if clinically warranted 1, 2

CT shoulder without contrast is rated 1/9 ("usually not appropriate") for biceps tendinitis evaluation, and CT arthrography adds no value for biceps tendon assessment 1, 2
MR arthrography is rated 1/9 ("usually not appropriate") for biceps tenosynovitis and does not add additional information compared with noncontrast MRI for biceps tendon pathology 1, 2, 4
Plain radiographs should be obtained first to rule out associated fractures or bony abnormalities, but they cannot visualize tendon pathology 3