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MRI of the Distal Biceps Femoris Muscle: Normal Anatomy, Variants, and Association with Common Peroneal Entrapment Neuropathy

¹ All authors: Department of Radiology, New York University (NYU) School of Medicine and NYU Hospital for Joint Diseases, 301 E 17th St., New York, NY 10003.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Drawing shows normal anatomy of common peroneal nerve (5). Note close relationship between distal biceps femoris insertion, lateral head of gastrocnemius muscle (7), and common peroneal nerve (circle). 1 = sciatic nerve, 2 = tibial nerve, 3 = long head of biceps femoris muscle, 4 = short head of biceps femoris muscle, and 6 = common tendon of biceps femoris. Reprinted with permission from HJD Graphics & Photo Department.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Measurement of posterior extent of short head of biceps femoris muscle performed on axial proton density (PD)-weighted (TR/TE, 2,000/32) image of knee in 30-year-old asymptomatic man. Line is drawn posterior to femoral condyles (solid line). Second line (dotted line) measures posterior extent of short head of biceps femoris muscle (asterisk) relative to solid line.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Comparison of two major patterns of downward course of common peroneal nerve in posterior knee on axial proton density (PD)-weighted images (TR/TE, 2,000/32). Absence of tunnel in 45-year-old asymptomatic woman. Common peroneal nerve (straight arrow) sits within large amount of fat. Short head of biceps femoris muscle (curved arrow) is quite small. Asterisk = lateral head of gastrocnemius muscle.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Comparison of two major patterns of downward course of common peroneal nerve in posterior knee on axial proton density (PD)-weighted images (TR/TE, 2,000/32). Presence of tunnel in 43-year-old asymptomatic woman. Common peroneal nerve (straight arrow) travels in narrow fatty passage (circle) between lateral head of gastrocnemius muscle (asterisk) and short head of biceps femoris muscle (curved arrow). Note that short head is much larger here in B than in A.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Presence of tunnel shown on sequential axial proton density (PD)-weighted images (TR/TE, 2,000/32) of 44-year-old asymptomatic woman. Common peroneal nerve (straight arrow) is situated within narrow tunnel (circle) between muscle of lateral gastrocnemius muscle (asterisk) and short head of biceps femoris muscle (curved arrow).

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Presence of tunnel shown on sequential axial proton density (PD)-weighted images (TR/TE, 2,000/32) of 44-year-old asymptomatic woman. Common peroneal nerve (straight arrow) is situated within narrow tunnel (circle) between muscle of lateral gastrocnemius muscle (asterisk) and short head of biceps femoris muscle (curved arrow).

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Presence of tunnel shown on sequential axial proton density (PD)-weighted images (TR/TE, 2,000/32) of 44-year-old asymptomatic woman. Common peroneal nerve (straight arrow) is situated within narrow tunnel (circle) between muscle of lateral gastrocnemius muscle (asterisk) and short head of biceps femoris muscle (curved arrow).

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Presence of tunnel shown on sequential axial proton density (PD)-weighted images (TR/TE, 2,000/32) of 44-year-old asymptomatic woman. Common peroneal nerve (straight arrow) is situated within narrow tunnel (circle) between muscle of lateral gastrocnemius muscle (asterisk) and short head of biceps femoris muscle (curved arrow).

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Distal extent of long head of biceps femoris muscle shown on sequential proton density (PD)-weighted axial images (TR/TE, 2,000/30) of knee in 50-year-old asymptomatic man. Long head (asterisk) ends more distal than is typical in this patient. Straight arrow = common peroneal nerve, curved arrow = short head.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Distal extent of long head of biceps femoris muscle shown on sequential proton density (PD)-weighted axial images (TR/TE, 2,000/30) of knee in 50-year-old asymptomatic man. Long head (asterisk) ends more distal than is typical in this patient. Straight arrow = common peroneal nerve, curved arrow = short head.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Common peroneal nerve entrapment in 14-year-old boy with clinical and electromyography evidence of common peroneal neuropathy. Axial T1 images (TR/TE, 466/9) (A, B, and D) and T2 fat-saturated image (3,800/119) (C) of knee show hypertrophied muscle belly of short head of distal biceps femoris muscle (curved arrow, A and B) associated with tunnel formation (circle, A and B). Common peroneal nerve (black arrow, A-C) is lying inside this tunnel, between short head of biceps femoris and lateral head of gastrocnemius muscle (asterisk, A and B) and has increased signal on T2-weighted image. There is also denervation edema and minimal denervation atrophy (white arrow, C and D) of anterior compartment of leg.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Common peroneal nerve entrapment in 14-year-old boy with clinical and electromyography evidence of common peroneal neuropathy. Axial T1 images (TR/TE, 466/9) (A, B, and D) and T2 fat-saturated image (3,800/119) (C) of knee show hypertrophied muscle belly of short head of distal biceps femoris muscle (curved arrow, A and B) associated with tunnel formation (circle, A and B). Common peroneal nerve (black arrow, A-C) is lying inside this tunnel, between short head of biceps femoris and lateral head of gastrocnemius muscle (asterisk, A and B) and has increased signal on T2-weighted image. There is also denervation edema and minimal denervation atrophy (white arrow, C and D) of anterior compartment of leg.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Common peroneal nerve entrapment in 14-year-old boy with clinical and electromyography evidence of common peroneal neuropathy. Axial T1 images (TR/TE, 466/9) (A, B, and D) and T2 fat-saturated image (3,800/119) (C) of knee show hypertrophied muscle belly of short head of distal biceps femoris muscle (curved arrow, A and B) associated with tunnel formation (circle, A and B). Common peroneal nerve (black arrow, A-C) is lying inside this tunnel, between short head of biceps femoris and lateral head of gastrocnemius muscle (asterisk, A and B) and has increased signal on T2-weighted image. There is also denervation edema and minimal denervation atrophy (white arrow, C and D) of anterior compartment of leg.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —Common peroneal nerve entrapment in 14-year-old boy with clinical and electromyography evidence of common peroneal neuropathy. Axial T1 images (TR/TE, 466/9) (A, B, and D) and T2 fat-saturated image (3,800/119) (C) of knee show hypertrophied muscle belly of short head of distal biceps femoris muscle (curved arrow, A and B) associated with tunnel formation (circle, A and B). Common peroneal nerve (black arrow, A-C) is lying inside this tunnel, between short head of biceps femoris and lateral head of gastrocnemius muscle (asterisk, A and B) and has increased signal on T2-weighted image. There is also denervation edema and minimal denervation atrophy (white arrow, C and D) of anterior compartment of leg.

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