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Chianca V, Sutter R, Grande FD. Imaging of Anatomical Variants Around the Elbow. Semin Musculoskelet Radiol 2023; 27:163-168. [PMID: 37011617 DOI: 10.1055/s-0043-1761957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The elbow is a synovial joint able to perform flexion, extension, supination, and pronation. Knowledge of anatomical variants is crucial to avoid misinterpretation during the evaluation of the elbow joint. We address those anatomical variants simulating pathologic conditions.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland
- Ospedale Evangelico Betania, Naples, Italy
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Akamatsu FE, Negrão JR, Rodrigues MB, Itezerote AM, Saleh SO, Hojaij F, Andrade M, Jacomo AL. Is there something new regarding triceps brachii muscle insertion? Acta Cir Bras 2020; 35:e202001007. [PMID: 33237178 PMCID: PMC7709896 DOI: 10.1590/s0102-865020200100000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. METHODS Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. RESULTS A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. CONCLUSION Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.
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Ciccotti MC, Ciccotti MG. Ulnar Collateral Ligament Evaluation and Diagnostics. Clin Sports Med 2020; 39:503-522. [DOI: 10.1016/j.csm.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh ® models of the anatomic findings. Skeletal Radiol 2020; 49:1057-1067. [PMID: 31993688 DOI: 10.1007/s00256-020-03382-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Assess the insertional anatomy of the distal aspect of the triceps brachii muscle using magnetic resonance imaging (MRI) in cadavers with histologic correlation and Play-doh® models of the anatomic findings. MATERIALS Elbows were obtained from twelve cadaveric arm specimens by transverse sectioning through the proximal portion of the humerus and the midportion of the radius and ulna. MRI was performed in all elbows. Two of the elbow specimens were then dissected while ten were studied histologically. Subsequently, Play-doh® models of the anatomic findings of the distal attachment sites of the triceps brachii muscle were prepared. RESULTS MRI showed a dual partitioned appearance of the distal attachment sites into the olecranon in all specimens. In the deeper tissue planes, the medial head muscle insertion was clearly identified while superficially, the terminal portion of the long and lateral heads appeared as a conjoined tendon. Histologic analysis, however, showed continuous tissue rather than separate structures attaching to the olecranon. CONCLUSION Although MRI appeared to reveal separate and distinct attachments of the triceps brachii muscle into the olecranon, histologic analysis delineated complex but continuous tissue related to the attachments of the three heads of this muscle. The Play-doh® models were helpful for the comprehension of this complex anatomy and might serve as a valuable educational tool when applied to the analysis of other musculoskeletal regions.
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Ciccotti MC, Ciccotti MG. Exam and Imaging of the Throwing Elbow. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lee HS, Lee YH, Jung I, Song OK, Kim S, Song HT, Suh JS. Optimization of MRI Protocol for the Musculoskeletal System. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:21-40. [PMID: 36238123 PMCID: PMC9432082 DOI: 10.3348/jksr.2020.81.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/05/2022]
Abstract
자기공명영상(magnetic resonance imaging; 이하 MRI)은 다른 영상 기법에 비해 연부 조직 대조도와 해상력이 높아 근골격계 영역에서 중요한 진단 기기로 이용되고 있다. 최근 MRI 관련 기술이 발달함에 따라 빠른 영상 촬영 및 다양한 영상면 재구성이 가능해짐으로써 입체적인 근골격계 해부학적 구조와 병변을 더욱 잘 평가할 수 있게 되었다. 또한, MRI는 최적화 정도에 따라 영상의 질, 진단 정확도 및 촬영 시간 등이 달라지며, MRI 장치의 효율적 인 운용과도 관련이 있어, 이를 관리하는 것은 영상의학과 의사의 중요한 역할이다. 본 종설에서는 6개 주요 관절에 따른 환자 자세, radiofrequency 코일 선택, 권장 펄스열, 영상면 구성 및 스캔 파라미터에 대한 지침을 제시함으로써 근골격계 MRI의 최적화에 도움이 되고자 한다.
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Affiliation(s)
- Hong Seon Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Inha Jung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Ok Kyu Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Taek Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
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Encinoso M, Orós J, Ramírez G, Jaber JR, Artiles A, Arencibia A. Anatomic Study of the Elbow Joint in a Bengal Tiger ( Panthera tigris tigris) Using Magnetic Resonance Imaging and Gross Dissections. Animals (Basel) 2019; 9:E1058. [PMID: 31805734 PMCID: PMC6940883 DOI: 10.3390/ani9121058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022] Open
Abstract
The objective of our research was to describe the normal appearance of the bony and soft tissue structures of the elbow joint in a cadaver of a male mature Bengal tiger (Panthera tigris tigris) scanned via MRI. Using a 0.2 Tesla magnet, Spin-echo (SE) T1-weighting, and Gradient-echo short tau inversion recovery (GE-STIR), T2-weighting pulse sequences were selected to generate sagittal, transverse, and dorsal planes. In addition, gross dissections of the forelimb and its elbow joint were made. On anatomic dissections, all bony, articular, and muscular structures could be identified. The MRI images allowed us to observe the bony and many soft tissues of the tiger elbow joint. The SE T1-weighted MR images provided good anatomic detail of this joint, whereas the GE-STIR T2-weighted MR pulse sequence was best for synovial cavities. Detailed information is provided that may be used as initial anatomic reference for interpretation of MR images of the Bengal tiger (Panthera tigris tigris) elbow joint and in the diagnosis of disorders of this region.
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Affiliation(s)
- Mario Encinoso
- Hospital Veterinario Los Tarahales, Recta de Los Tarahales 15, 35013 Las Palmas de Gran Canaria, Spain; (M.E.); (A.A.)
| | - Jorge Orós
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35416 Las Palmas, Spain; (J.O.); (J.R.J.)
| | - Gregorio Ramírez
- Departamento de Anatomía y Anatomía Patológica, Universidad de Murcia, 30100 Murcia, Spain;
| | - José Raduan Jaber
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35416 Las Palmas, Spain; (J.O.); (J.R.J.)
| | - Alejandro Artiles
- Hospital Veterinario Los Tarahales, Recta de Los Tarahales 15, 35013 Las Palmas de Gran Canaria, Spain; (M.E.); (A.A.)
| | - Alberto Arencibia
- Departamento de Morfología, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria, Trasmontaña, Arucas, 35416 Las Palmas, Spain; (J.O.); (J.R.J.)
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Lenz R, Bonacker J, Mittelmeier W, Ellenrieder M, Tischer T. [What do orthopedic and trauma surgeons expect from radiologists when interpreting imaging of the elbow?]. Radiologe 2019; 58:968-975. [PMID: 30225771 DOI: 10.1007/s00117-018-0456-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CLINICAL ISSUE The elbow is a complex joint with a multitude of acute and chronic pathologies. In addition to the clinical examination, radiological diagnostics play a decisive role in the further therapeutic management. DIAGNOSTIC WORK-UP/PERFORMANCE While acute traumatic injuries often present with obvious structural changes and the need for rapid treatment decisions, chronic processes can present with less evident alterations. Especially in these cases there is a need for clear communication between the treating physician and the radiologist with respect to managing optimal imaging as the basis for a certain diagnosis and therefore optimal treatment. Basic prerequisites on both sides are detailed knowledge of all elbow pathologies, classifications and the spectrum of radiological diagnostic imaging. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS From the point of view of orthopedic surgeons the radiologist is responsible for the correct performance and interpretation of the necessary imaging procedures. The aim of this article is to give an overview of important aspects in the imaging of typical orthopedic/traumatic pathologies.
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Affiliation(s)
- R Lenz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland.
| | - J Bonacker
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - W Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - M Ellenrieder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - T Tischer
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
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Brandão AT, Amaro Junior E, Francisco Neto MJ, Tanaka RM, Santos DDCB, Miranda FC, Rahal Junior A, Rosemberg LA. Ultrasonography and magnetic resonance imaging of elbow ligaments: a comparative study. EINSTEIN-SAO PAULO 2019; 17:eAO4579. [PMID: 31166410 PMCID: PMC6550434 DOI: 10.31744/einstein_journal/2019ao4579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/26/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: To determine the value of ultrasonography in elbow ligament assessment compared to magnetic resonance imaging. Methods: A prospective single-center study involving 30 volunteers with no elbow joint changes. Two experienced ultrasound specialists evaluated both elbows of each volunteer, resulting in 60 evaluations per physician and totaling up 120 evaluations. Magnetic resonance images were obtained using a 3-Tesla machine and evaluated by two experienced radiologists, totaling up 120 exams. Each examiner assigned subjective, zero-to-5 scores to ligaments imaged, where zero corresponded to non-identified ligament and 5 to visualization of the entire ligament. The level of significance was set at 5%. Bland-Altman dispersions and plots were prepared for each pair of measurements obtained. Results: All ligaments were amenable to sonographic identification; scores of 4 or 5 were assigned by examiners based on ligament visibility. Ligaments could also be identified using magnetic resonance imaging and were assigned scores of 5 by examiners. All ligaments were described as intact and healthy by all four examiners. Comparative analysis of elbow ligament sonographic and magnetic resonance imaging findings did not differ significantly. Conclusion: Ultrasonography and magnetic resonance imaging can be considered equivalent modalities for elbow ligament assessment in the hands of experienced examiners.
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Affiliation(s)
| | | | | | - Rubens Mitsuo Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Frederico Celestino Miranda
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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The elbow: review of anatomy and common collateral ligament complex pathology using MRI. Insights Imaging 2019; 10:43. [PMID: 30945023 PMCID: PMC6447645 DOI: 10.1186/s13244-019-0725-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/25/2019] [Indexed: 11/30/2022] Open
Abstract
The elbow is a complex joint whose stability is imparted by osseous and soft-tissue constraints. Anatomical and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret the pathological findings. Conventional MRI and MR arthrography are the imaging modalities of choice in the evaluation of elbow ligament injuries. Elbow instability can be classified according to timing (acute, chronic, or recurrent), the direction of displacement, the degree of displacement, and the articulations involved. This article reviews the MR imaging protocols recommended for each diagnosis and the normal anatomy and biomechanical aspects of the medial and lateral collateral ligament complex. We also present multiple cases of typical and atypical patterns of injury.
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Takahashi T, Itoh S, Kida M. Availability of ultrasound screening for asymptomatic elbow injuries in judo athletes. Biomed Mater Eng 2018; 30:49-59. [PMID: 30562889 DOI: 10.3233/bme-181032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We conducted ultrasonography (US) examination for asymptomatic elbow injuries in judo athletes to confirm availability of US screening for elbow. MATERIALS AND METHODS One hundred and thirty-two black belts in judo (85 males and 47 females; mean age, 20.0 ± 1.6 years) participated in this screening. Forty-eight participants had a history of elbow injury (elbow-injury group), and 84 did not (no-elbow-injury group). All participants completed a survey in the form of a questionnaire. Subsequently, US scanning of both elbows was performed. RESULTS The maximal thickness of the medial collateral ligament of both elbows was significantly larger in the elbow-injury group than in the no-elbow-injury group. The width of the joint space was significantly larger in the right radiohumeral joint in the elbow-injury group than in the no-elbow-injury group. Combination injuries involving ligament and bone and those involving both the medial and lateral collateral ligaments were most commonly seen in both elbows in the elbow-injury group; however, these combined lesions of both elbows were also found in the no-elbow-injury group. CONCLUSIONS Because US screening can reveal abnormalities of the asymptomatic elbow, US is recommended as a complementary imaging modality that is useful for evaluation of elbow injuries in athletes.
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Affiliation(s)
- Tatsunori Takahashi
- Department of Tokyo-Judo Therapy, Faculty of the Medical Sciences, Teikyo University of Science, 2-2-1 Senju Sakuragi, Adachi-ku, Tokyo, Japan
| | - Soichiro Itoh
- Department of Inorganic Materials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, Japan
| | - Masakazu Kida
- Department of Orthopedic Surgery, Kawakita General Hospital, 1-7-3 Asagaya-kita, Suginami, Tokyo, Japan
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Correlation of MRI to Arthroscopy in the Elbow: Thrower's Elbow and Ulnar Collateral Ligament Injury. Sports Med Arthrosc Rev 2017; 25:191-198. [PMID: 29095397 DOI: 10.1097/jsa.0000000000000165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One cannot overstate the importance of a thorough history and physical examination, supplemented with directed imaging, to help pinpoint the exact cause of the athlete's elbow pain. Although plain radiographs should not be overlooked, advanced imaging plays a critical role in diagnosis and management of pathology in the thrower's elbow, including computed tomography, magnetic resonance imaging, and stress ultrasound. By judiciously combining these elements, the clinician can appropriately manage these injuries in order to successfully return the athlete to their preinjury level of play.
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Jarraya M, Crema MD, Engebretsen L, Teytelboym OM, Hayashi D, Roemer FW, Skaf AY, Guermazi A. Epidemiology of imaging-detected tendon abnormalities in athletes participating in the Rio de Janeiro 2016 Summer Olympics. Br J Sports Med 2017; 52:465-469. [PMID: 29051166 DOI: 10.1136/bjsports-2017-098187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tendon abnormalities are prevalent among both elite and non-elite athletes. Cross-sectional imaging modalities are used to confirm and evaluate the severity of such lesions. AIM To describe the demographics, prevalence, anatomical location and characteristics of tendon abnormalities in athletes who participated in the Rio de Janeiro 2016 Summer Olympic Games. METHODS We recorded all sports injuries reported by the National Olympic Committee (NOC) medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the official IOC clinic within the Olympic Village, using digital ultrasound machines and 3T and 1.5T MR scanners. Image interpretation was performed centrally by board-certified musculoskeletal radiologists with expertise in sports injuries. RESULTS In total, 11 274 athletes (5089 women (45%), 6185 men (55%)) from 207 NOCs were included. NOC and Rio de Janeiro 2016 medical staff reported 1101 injuries. Central review of radiological images revealed 156 tendon abnormalities in 109 athletes (51.2% male, mean age: 26.8, range 18-39). The supraspinatus tendon was the most commonly involved tendon (31 cases, 19.9%), followed by the Achilles tendon (20 cases, 12.8%) and patellar and infraspinatus tendons (12 cases, 7.7%). Tendon abnormalities were most commonly seen in track and field athletes (54 abnormalities, 34.6%). CONCLUSION 156 tendon abnormalities were reported, most commonly in track and field athletes, and involving mainly the shoulder tendons, as well as Achilles and patellar tendons.
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Affiliation(s)
- Mohamed Jarraya
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Radiology, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
| | - Michel D Crema
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France.,Department of Sports Medicine, National Institute of Sports (INSEP), Paris, France
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.,Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Oleg M Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
| | - Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Radiology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Frank W Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Abdalla Y Skaf
- Department of Radiology, HCor Hospital and ALTA Diagnostic Center (DASA group), Sao Paulo, Brazil
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
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15
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Ultrasound imaging of the humeral capitellum: a cadaveric study. J Orthop Sci 2014; 19:907-12. [PMID: 25196792 DOI: 10.1007/s00776-014-0637-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/15/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Ultrasound is suitable for routine examinations of capitellar osteochondritis dissecans because it can visualize both the subchondral bone and the overlying articular cartilage non-invasively. The radial head interferes with the sonographically visible area of the articular surface of the humeral capitellum, although the precise extent of this is currently unknown. This study aimed to investigate the visible area of the humeral capitellum using both anterior and posterior ultrasonographic scans. METHODS Twelve elbows were used from cadavers with a mean age of 85.6 years. After marking a 45° angle in the anterior capitellum in a caudal direction using a drill, anterior and posterior, long-axis ultrasonographic scans were performed with the cadaveric elbows bent. The elbow-flexion angle at which the 45° point was obscured by the radial head was measured and these ultrasonic measurements were then verified by macroscopic observation. RESULTS The elbow-flexion angle at which the 45° point was obscured by the radial head was 24° in anterior scans and 102° in posterior scans. These ultrasonic measurements corresponded to the macroscopic measurements. The results showed that anterior, long-axis ultrasound scans could visualize the capitellum from 45° through the rest of the anterior area at 24° flexion of the elbow: the radial head obscured the area of the capitellum that is 21° anterior to the elbow flexion angle. Similarly, posterior long-axis scans could visualize the capitellum from 45° through the rest of the posterior area at 102° flexion of the elbow: the radial head obscured the area of the capitellum that is 57° posterior to the elbow flexion angle. The radial head obscured a 78° (21° + 57°) arc of the capitellum in ultrasonography. CONCLUSIONS This study thus clarified the area of the humeral capitellum visible in both anterior and posterior ultrasound scans in the sagittal plane.
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Rehm J, Zeifang F, Weber MA. [Imaging of the elbow joint with focused MRI. Part 1: examination techniques and sequences for bone and ligaments]. Radiologe 2014; 54:167-80. [PMID: 24435158 DOI: 10.1007/s00117-013-2607-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Imaging of the elbow joint places high demands on the quality of imaging due to the challenging anatomy and the sometimes subtle findings. For the diagnosis of periarticular soft tissues, ligamentous structures and in individual cases for fracture and tumor diagnosis, magnetic resonance imaging (MRI) is mostly groundbreaking and allows a reliable diagnosis in most cases. This review article discusses the complex imaging anatomy and anatomical variants of this joint and the most common osseous and ligamentous injuries of the elbow joint are presented. The typical MRI findings and indications are illustrated and discussed and possible pitfalls are pointed out. The various examination techniques and MRI sequences are also addressed.
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Affiliation(s)
- J Rehm
- Abteilung Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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Rehm J, Zeifang F, Weber MA. Bildgebung des Ellenbogengelenks mit Fokus MRT. Radiologe 2014; 54:279-92; quiz 293-4. [DOI: 10.1007/s00117-013-2643-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
CONTEXT The elbow is a complex joint and commonly injured in athletes. Evaluation of the elbow by magnetic resonance imaging (MRI) is an important adjunct to the physical examination. To facilitate accurate diagnosis, a concise structured approach to evaluation of the elbow by MRI is presented. EVIDENCE ACQUISITION A PubMed search was performed using the terms elbow and MR imaging. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the MRI appearance of normal anatomy and common pathology of the elbow. RESULTS The spectrum of common elbow disorders varies from obvious acute fractures to chronic overuse injuries whose imaging manifestations can be subtle. MRI evaluation should include bones; lateral, medial, anterior, and posterior muscle groups; the ulnar and radial collateral ligaments; as well as nerves, synovium, and bursae. Special attention should be paid to the valgus extension overload syndrome and the MRI appearance of associated injuries when evaluating throwing athletes. CONCLUSION MRI evaluation of the elbow should follow a structured approach to facilitate thoroughness, accuracy, and speed. Such an approach should cover bone, cartilage, muscle, tendons, ligaments, synovium, bursae, and nerves.
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Affiliation(s)
- Srinath C Sampath
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Srihari C Sampath
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miriam A Bredella
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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19
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Elbow Injuries at the London 2012 Summer Olympic Games: Demographics and Pictorial Imaging Review. AJR Am J Roentgenol 2013; 201:535-49. [DOI: 10.2214/ajr.13.10897] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
The overhead throwing motion is a complex sequence of maneuvers that requires coordinated muscle activity in the upper and lower extremities. The shoulder and elbow are subject to multidirectional forces and are particularly vulnerable to injury during specific phases of the overhead throwing motion. Ligamentous, tendinous, neural, and osseous pathology that may occur in the shoulder or elbow of an overhead-throwing athlete will be discussed, with an emphasis on the role of MR imaging and MR arthrography.
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Affiliation(s)
- Neel B Patel
- Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA.
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21
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Correlation of preoperative MRI and MRA with arthroscopically proven articular cartilage lesions of the elbow. Clin J Sport Med 2012; 22:403-7. [PMID: 22929044 DOI: 10.1097/jsm.0b013e318266c735] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in detecting elbow articular cartilage injuries through comparison of preoperative MRI and magnetic resonance arthrography (MRA) with arthroscopic findings. DESIGN Retrospective case analysis. SETTING Tertiary care orthopedic private practice. PATIENTS Consecutive series of 31 patients presenting with elbow pain and diagnosed at arthroscopy with articular cartilage defects of the elbow. All patients had a preoperative MRI or MRA using a 1.5 T magnet. INTERVENTIONS Each patient had a systematic elbow arthroscopy, with careful inspection and recording of chondral injuries in 4 anatomical regions: capitellum, radius, trochlea, and ulna. Each MRI/MRA was then independently reviewed by 2 radiologists blinded to the arthroscopic findings. MAIN OUTCOME MEASURES The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated for MRI and MRI compared with arthroscopy as the gold standard, for each of the anatomical regions. RESULTS The accuracy of MRI was 45% for chondral injuries of the radius, 65% for the capitellum, 20% for the ulna, and 30% for the trochlea. The accuracy of MRA was 45% for chondral injuries of the radius, 64% for the capitellum, 18% for the ulna, and 27% for the trochlea. CONCLUSION We conclude that the ability of MRI and MRA using a 1.5 T magnet to detect articular cartilage lesions is limited. Neither MRI nor MRA demonstrates the intraarticular surface as accurately as direct visualization with the arthroscopy. This may be improved with the use of 3 T MRI. CLINICAL RELEVANCE This study demonstrates that MRI and MRA with a 1.5 T magnet, as used in community practice, have limited ability to detect cartilage lesions of the elbow.
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22
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Jans LB, Ditchfield M, Anna G, Jaremko JL, Verstraete KL. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Eur J Radiol 2012; 81:1306-10. [DOI: 10.1016/j.ejrad.2011.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/04/2011] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
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23
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Lin CW, Chen YH, Chen WS. Application of Ultrasound and Ultrasound-Guided Intervention for Evaluating Elbow Joint Pathologies. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Anderson MW, Alford BA. Overhead Throwing Injuries of the Shoulder and Elbow. Radiol Clin North Am 2010; 48:1137-54. [DOI: 10.1016/j.rcl.2010.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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25
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Detailed MRI-anatomic study of the lateral epicondyle of the elbow and its tendinous and ligamentous attachments in cadavers. AJR Am J Roentgenol 2010; 195:629-36. [PMID: 20729438 DOI: 10.2214/ajr.09.3173] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to document discrete bone landmarks in the lateral epicondyle of the humerus that represent the "footprints" of those tendons and ligaments that attach to it using MRI-anatomic correlation in cadavers. MATERIALS AND METHODS Thirty-three dried humeral specimens were inspected to document bone landmarks in the lateral epicondyle. MRI with anatomic correlation was performed in 10 additional cadaveric elbows. The locations of the tendinous and ligamentous attachments to the lateral epicondyle were determined with respect to the same osseous landmarks. RESULTS The surface of the lateral epicondyle ranged from a flat surface to a surface with up to six discrete landmarks: superior tubercle, anterior tubercle, posterior tubercle, intertubercular sulcus, rough area surrounding the tubercles, and epicondylar ridge. The radial collateral ligament attached to the superior aspect of the intertubercular sulcus and inferior aspect of the superior tubercle and was indistinguishable from the attachment of the lateral ulnar collateral ligament. The extensor carpi radialis brevis, extensor digitorum communis, and extensor digiti minimi had a common origin in the superior aspect of the lateral epicondyle. The extensor carpi ulnaris tendon arose from the posteroinferior aspect of the lateral epicondyle. CONCLUSION Our investigation documents osseous landmarks that are useful in the identification of the footprints of the tendons and ligaments that attach to the lateral epicondyle. Knowledge of these structures contributes to correct interpretation of MR images in persons with tendinous and ligamentous abnormalities in this region.
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Abstract
Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. Prompt recognition of this disorder and institution of nonoperative treatment for early, stable lesions can result in healing with later resumption of sporting activities. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. The introduction of elbow arthroscopy in the treatment of osteochondritis dissecans of the capitellum permits a thorough lesion assessment and evaluation of the entire elbow joint with the ability to treat the lesion and coexistent pathology in a minimally invasive fashion. Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising.
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Affiliation(s)
- Champ L Baker
- Hughston Clinic, 6262 Veterans Parkway, Columbus, GA 31909, USA.
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27
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MR Imaging in Congenital and Acquired Disorders of the Pediatric Upper Extremity. Radiol Clin North Am 2009. [DOI: 10.1016/j.rcl.2009.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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MR imaging in congenital and acquired disorders of the pediatric upper extremity. Magn Reson Imaging Clin N Am 2009; 17:549-70, vii. [PMID: 19524202 DOI: 10.1016/j.mric.2009.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Various congenital and acquired disorders can affect the upper extremity in pediatric and adolescent patients. MR imaging can provide unique anatomic and diagnostic information in the evaluation of many of these disorders, including inflammatory, infectious, neoplastic, and arthritic conditions. This article rounds out the issue on pediatric musculoskeletal MR imaging. It focuses on the evaluation of more common congenital disorders, and mainly sports-related injuries of the shoulder, elbow, and wrist in children. MR imaging can be more challenging in diagnosis of some of these disorders. Features of overuse injuries in skeletally immature athletes are a unifying theme throughout the article.
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MR imaging findings of anterior interosseous nerve lesions. Skeletal Radiol 2007; 36:1155-62. [PMID: 17938918 DOI: 10.1007/s00256-007-0382-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 08/15/2007] [Accepted: 08/18/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study and characterise the MR imaging findings of lesions of the anterior interosseous nerve (AIN). MATERIALS AND METHODS Magnetic resonance imaging (MRI) findings of the forearm of ten patients referred to our institution with suspected AIN lesions were retrospectively studied. Five healthy volunteers with normal forearm MRI findings formed a control group. Two musculoskeletal radiologists assessed the forearm musculature for oedema in the distribution of the AIN, median, posterior interosseous and radial nerves on T2-weighted (T2W) fat-saturated sequences. T1-weighted (T1W) images were assessed and graded for the presence of muscle atrophy and fatty involution. RESULTS Six patients had undergone surgical exploration; five of these had surgically confirmed AIN compression. Four patients had diagnoses other than AIN compression made on imaging features. Of the cases of proven AIN compression, oedema within the pronator quadratus (PQ) muscle was identified in all cases. PQ atrophy and fatty involution were seen in three (43%) surgically confirmed cases. Cases 2 and 3 also demonstrated oedema in the flexor digitorum profundus (FDP)1 and FDP2 muscles. These cases also showed oedema in the flexor-carpi radialis (FCR) and FDP3/FDP4 muscles, respectively. The four cases of non-AIN compression demonstrated muscle oedema patterns that were atypical for the AIN distribution. They included a rupture of the flexor pollicis longus (FPL) tendon, brachial neuritis, amyotrophic lateral sclerosis and compression of the proximal median nerve. CONCLUSIONS MRI is a useful investigation in the diagnostic workup of AIN syndrome. AIN syndrome is likely when there is diffuse oedema of AIN innervated muscles on T2W fat-saturated images. The most reliable sign of an AIN lesion is oedema within the PQ. Oedema in the flexor carpi radialis, FDP3 and FDP4, although not in the classical distribution of the AIN, does not preclude the diagnosis of AIN syndrome.
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30
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Wahegaonkar AL, Doi K, Hattori Y, Addosooki A. Technique of osteochondral autograft transplantation mosaicplasty for capitellar osteochondritis dissecans. J Hand Surg Am 2007; 32:1454-61. [PMID: 17996784 DOI: 10.1016/j.jhsa.2007.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 08/22/2007] [Indexed: 02/02/2023]
Abstract
Osteochondritis dissecans (OCD) is a localized condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Various theories about its etiology have been proposed, but the exact etiology of OCD still remains obscure. Osteochondritis dissecans of the elbow is characterized by pain, swelling, and limitation of motion, usually in adolescence through early adulthood. An uncommon clinical entity, it occurs as a result of overuse injuries, especially throwing activities. The treatment of OCD has evolved from the removal of loose bodies to the resurfacing of defects with an osteochondral autogenous graft (mosaicplasty). Mosaicplasty is a relatively new and viable option for the treatment of advanced OCD of the capitellum. In this article, we describe the technique of mosaicplasty for OCD of the capitellum.
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Affiliation(s)
- Abhijeet L Wahegaonkar
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi- City, Yamaguchi, Japan.
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31
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Frick MA. Reprint of imaging of the elbow: a review of imaging findings in acute and chronic traumatic disorders of the elbow. J Hand Ther 2007; 20:186-200; quiz 201. [PMID: 17533097 DOI: 10.1197/j.jht.2007.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Imaging, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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32
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33
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Park J, Park H. Osteochondral Lesion of Elbow Joint. Clin Shoulder Elb 2006. [DOI: 10.5397/cise.2006.9.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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34
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Frick MA. Imaging of the elbow: a review of imaging findings in acute and chronic traumatic disorders of the elbow. J Hand Ther 2006; 19:98-112. [PMID: 16713859 DOI: 10.1197/j.jht.2006.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Imaging, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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35
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Rahusen FTG, Brinkman JM, Eygendaal D. Results of arthroscopic debridement for osteochondritis dissecans of the elbow. Br J Sports Med 2006; 40:966-9. [PMID: 16980533 PMCID: PMC2577458 DOI: 10.1136/bjsm.2006.030056] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the clinical outcome of arthroscopic debridement for osteochondritis dissecans of the elbow. METHODS A prospective cohort study was started in 2000; between 2000 and 2005, 15 patients (six male, nine female, mean age 28 years (range 16-49)) were treated for osteochondritis dissecans of the elbow with arthroscopic debridement. The lesion was graded during surgery using the classification of Baumgarten. The dominant side was operated on in seven of 15 patients, and all patients were involved in a sport in which the elbow is used extensively. Elbow function was assessed before and after surgery using the modified Andrews elbow scoring system (MAESS); pain was scored on a visual analogue scale (0, no pain; 10, severe pain). Evaluation was performed an average of 45 (range 18-59) months after surgery. Statistical analysis (Student's t test) was carried out using SPSS statistical software. p<0.005 was considered significant. RESULTS There were no complications. The range of motion did not improve significantly. The mean MAESS score improved from 65.5 (poor) before surgery to 90.8 (excellent) after (p<0.001). The mean level of pain at rest decreased from 3 to 1, and the level of pain after provocation decreased from 7 to 2 (p<0.001). All patients were able to return to work 3 months after surgery, and 80% were able to resume their pre-injury level of sport activity. CONCLUSION The clinical outcome after arthroscopic debridement for osteochondritis dissecans of the elbow shows good results, with pain relief during activities of daily living and sport. The function of the elbow, as reflected by the MAESS score, improved from poor to excellent. All patients in this series will be reviewed after 5 years to determine long-term results.
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Affiliation(s)
- F Th G Rahusen
- Department of Orthopaedics, St Maartenskliniek, Nijmegen, the Netherlands.
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36
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Abstract
Competitive athletics in school-aged children has become the norm rather than the exception. The increased repetitive stresses placed on the upper extremity in a wide variety of sports result in a host of injuries unique to the skeletally immature athlete. This article focuses on a discussion of the more common upper extremity injuries encountered in the child athlete and the role of radiography and MRI in diagnosis and management.
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Affiliation(s)
- Kathleen H Emery
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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37
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Tuite MJ, Kijowski R. Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med 2006; 25:387-408, v. [PMID: 16798134 DOI: 10.1016/j.csm.2006.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
MRI is a valuable tool for evaluating the athlete with elbow pain, particularly in those with nonlocalizable pain. MRI also is helpful in sorting out the cause of pain in athletes who may have acute trauma superimposed on tendinopathy or other chronic injuries from repetitive microtrauma. Even in athletes in whom the cause of pain confidently can be diagnosed clinically, MRI can document the injury severity, which can be helpful for estimating recovery time or in preoperative planning. By contributing to an accurate early diagnosis, MRI also can help minimize the time that athletes are away from their sports. The authors describe their approach to the MRI interpretation of elbow injuries in athletes, including osteochondral lesions, epicondylitis, and tears of the medial collateral ligament.
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Affiliation(s)
- Michael J Tuite
- University of Wisconsin Medical School, 750 Highland Avenue, Madison, WI 53705 USA.
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38
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Brunton LM, Anderson MW, Pannunzio ME, Khanna AJ, Chhabra AB. Magnetic resonance imaging of the elbow: update on current techniques and indications. J Hand Surg Am 2006; 31:1001-11. [PMID: 16843164 DOI: 10.1016/j.jhsa.2006.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 04/17/2006] [Accepted: 04/17/2006] [Indexed: 02/02/2023]
Abstract
The utility of magnetic resonance imaging of the elbow has noticeably improved over the past decade. Advances in equipment and refinement of pulse sequences has allowed for superior visualization of many pathologic processes involving the elbow joint and its surrounding structures. At this time, magnetic resonance imaging is most valuable in detecting occult fractures, osteochondritis dissecans, collateral ligament tears, nonossified intra-articular loose bodies, and soft tissue masses. It may also aid in the diagnosis of tendinous injuries, compression neuropathies, and synovial disorders. This article serves as an educational update for hand surgeons and illustrates the features of normal anatomy and specific disorders of the elbow.
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Affiliation(s)
- Lance M Brunton
- Department of Orthopaedic Surgery University of Virginia Hand Center, University of Virginia Health System, Charlottesville, VA 22903, USA
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