Presentation1.pptx mri of elbow jointPresentation Transcript
MRI of the elbow joint.
Dr/ ABD ALLAH NAZEER. MD
Imaging of the Elbow Joint
Anatomy and Pitfalls
MR anatomy of the elbow joint
Normal distal biceps tendon . At conventional
MR images, longitudinal views
are difficult to obtain because of the oblique
course of the tendon (arrows). MR images
obtained with the patient in the FABS position
shows a normal distal biceps tendon (open
arrows), the musculotendinous junction (open
arrowhead), and the radial tuberosity (solid
Ulnar collateral ligament (UCL) injury refers to a
sprain, partial tear or complete tear of the
ligament that traverses the inside (or medial
side) of the elbow. The UCL is the primary
stabilizer of the elbow and plays an important
role in throwing and hitting sports, such as
baseball, football and tennis.
Additional findings: Strain or rupture of the
common flexor tendon, ulnar neuropathy, ulnar
traction spurring or heterotopic ossification of
the soft tissues
and medial flexor insertion pronator tear.
Complete tear of the LUCL.
Lateral epicondylitis, commonly known as tennis
elbow, is a painful condition involving the tendons that
attach to the bone on the outside (lateral) part of the
elbow. Tendons anchor the muscle to bone. The muscle
involved in this condition, the extensor carpi radialis
brevis, helps to extend and stabilize the wrist . With
lateral epicondylitis, there is degeneration of the
tendon’s attachment, weakening the anchor site and
placing greater stress on the area. This can then lead to
pain associated with activities in which this muscle is
active, such as lifting, gripping, and/or grasping. Sports
such as tennis are commonly associated with this, but
the problem can occur with many different types of
activities, athletic and otherwise.
Medial epicondylitis, or "golfer's elbow,"
is similar to the more common lateral
epicondylitis ("tennis elbow") in many
respects. Both conditions are overuse
tendinopathies that can be associated with
racquet sports. Other activities with which
medial epicondylitis is associated include
golfing and throwing sports. Medial
epicondylitis has also been reported in
bowlers, archers, and weight lifters.
Medial epicondylitis (Golfer's elbow). Coronal fat-suppressed proton
density-weighted MR images . On the left image, a partial tear of the
common flexor tendon (white arrow) is observed. On the right
image, the common flexor tendon origin is usually thickened and shows
increased signal intensity (yellow arrow).Note the presenc of subtle
bone marrow edema in the medial epicondyle (blue arrow).
Little Leaguer’s Elbow
The medial epicondyle of the affected arm is
somewhat more osteopenic.
In these cases we usually ask for a comparison
view, because it can be very subtle.
The diagnosis is a Little leaguer's elbow which
results from chronic stress injury.
The lucency on the radiograph, which looks
like a widened physis, is due to cartilage
ingrowth in the metaphysis.
Little Leaguer’s Elbow
Little Leaguer’s Elbow
short head (white arrow). Note the presence of fluid signal filling the tendinous gaps.
Findings are far more conspicuous in the FABS position
Biceps tendon tear.
Complete triceps tendon tear
Triceps tendon tear with hemorrhage.
Nerve pathology and entrapment Neuropathies.
Ulnar nerve neuropathy(Cubital tunnel syndrome).
MR images of the left elbow demonstrating
increased signal in the thickened ulnar nerve
Osteochondral defects are focal areas of articular
damage with cartilage damage and injury of the
adjacent subchondral bone. It is a term that
encompasses osteochondritis dissecans, and
is used synonymously with osteochondral injury /
defect in the paediatric population.
osteochondritis dissecans thought to be due to
Osteochondritis dissecans of the capitulum
Panner’s disease Occurs in children (age <10)
Osteochondrosis of capitulum due to localized avascular
necrosis Signs and Symptoms Sudden pain at radiohumeral
Arthritis of the Elbow
The most common cause of arthritis of the elbow is rheumatoid
arthritis. Osteoarthritis and injuries can also cause arthritis in the
Rheumatoid arthritis is a disease of the joint linings, or synovia.
As the joint lining swells, the joint space narrows. The disease
gradually destroys the bones and soft tissues. Usually, RA affects
both elbows, as well other joints such as the hand, wrist and
Osteoarthritis affects the cushioning cartilage on the ends of the
bones that enables them to move smoothly in the joint. As the
cartilage is destroyed, the bones begin to rub against each other.
Loose fragments within the joint may accelerate degeneration.
Trauma or injury to the elbow can also damage the cartilage of
the joint. This can lead to the development of arthritis in the
MRI showed intraarticular fluid and a fibrous
intraarticular pannus in rheumatoid arthritis.