discussion about elbow diseases & how to identify in radiology

2. Use the axis of the
epicondyles on a axial
localizer to plan the
coronal scan.
The sagittal images are
scaned perpendicular to
the coronal scan.
In this way you get very
persistent images and you
will get used to the
normal anatomy.

5. Typically the
radiocapitellar joint is
punctured from lateral
with the patient prone
and the arm flexed 90
degrees overhead
(red arrow)

6.  UCL pathology in throwers.
 Osteochondral lesions and repair
 Loose bodies

9.  This is a finding that you frequently see on coronal
images.
It looks like an osteochondral lesion, but if you look at
the sagittal image you will notice that the coronal
image runs through the posterior non-articular
portion of the capitellum.

12.  All these forces make up what is called the
"valgus overload syndrome" with very
characteristic injuries to the elbow over
time.
 The tension on the medial side causes a
tear of the ulnar collateral ligament.
 Compression on the lateral side causes an
osteochondral lesion of the capitellum.
 The shear forces on the posterior side
cause arthrosis.

17. A lateral view of the
elbow of a patient who
fell on the outstretched
arm.
The radiograph shows
joint effusion (red
arrows) and a coronoid
fracture (yellow arrow).

18. Coronal view:
Lateral collateral ligament is
completely stripped (yellow
arrow).
radial head is subluxed.
marrow edema of the coronoid
process due to the fracture (red
arrow).
Sagittal view:
Radial head is a little bit subluxed
posteriorly (yellow arrow).
Large effusion and capsular
disruption posteriorly.
Contusion of the posterior side of
the capitellum as a result of
impaction by the coronoid process
(red arrow).

19. Osteochondral lesion is the
new name for
osteochondritis dissecans
or OCD.
The chronic valgus
overload can cause an
osteochondral lesion on
the lateral side of the
elbow.
It is the result of repetitive
impaction and shear forces.

21. The ulnar collateral ligament
(UCL) is situated on the medial
side and it has three
components. The anterior
bundle is the strongest
component and is the primary
restraint against valgus forces.
On MR this is the most
important structure.
The posterior bundle attaches
distally in a fan-shape on the
olecranon.
It forms the floor of the cubital
tunnel.

23. It consists of the radial
collateral, the lateral
ulnar collateral and the
annular ligament.

24. When you look for the radial
collateral ligament, first try to
identify the common
extensor tendon, because
right underneath it you will
find the radial collateral
ligament (yellow arrow).
As you go more posteriorly
you will see the LUCL - the
lateral ulnar collateral
ligament, which sweeps
behind the radial head (white
arrows).

25. The common extensor tendon originates at the lateral epicondyle.
On a T1W-images the tendon should have a low signal intensity
(yellow arrow).

26. Lateral epicondylitis is also
known as the tennis elbow,
although in 95% of cases it is
seen in non-tennis players.
It is due of chronic stress to the
common extensor tendon, which
results in partial tearing and
tendinosis.
Typically, the extensor carpi
radialis brevis is the component
that is involved.

27. Here a typical case.
There is thickening
and abnormal
intrinsic signal on
both T1- and T2W-
images.

28. The common flexor
tendon originates at
the medial epicondyle.
On a T1W-images the
tendon should have a
low signal intensity
(red arrow).

30. Here the common flexor
tendon is involved.
On the sagittal image it is
clear that it is only partial
tearing.
However this can be quite
painful.
Here we have the coronal
T1W- and T2W-images.
There is partial tearing, but it
is very extensive.

31. 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.

32. On the MR the abnormality
is very obvious.
There is marrow edema in
the medial epicondyle and
also in the adjacent bone
(yellow arrow).
Little Leaguer's elbow is also
known as medial apophysitis
and some call it
epiphysiolysis. Notice the
normal ulnar collateral
ligament (red arrow).

33. Here we see the ulnar
nerve within the cubital
tunnel.
The posterior band of
the ulnar collateral band
forms the floor of the
tunnel, while the
retinaculum forms the
roof.

34. Cubital tunnel syndrome
is a common peripheral
neuropathy.
It arises from
compression of the ulnar
nerve within the cubital
tunnel, where the nerve
passes beneath the
cubital tunnel
retinaculum.

35.  Overuse
 Subluxation of the ulnar nerve because of congenital
laxity in the fibrous tissue
 Humeral fracture with loose bodies or callus formation
 Arthritic spur arising from the epicondyle or
olecranon,
 Muscle anomaly (eg: an accessory anconeus muscle) as
is present in this case.
 Soft-tissue mass: ganglion, lipoma, osteochondroma,
synovitis secondary to rheumatoid arthritis, infection
(eg: tuberculosis), and hemorrhage.

36. Thank You