25, No. This was due to proximal radial neuropathy. If the condition fails to respond to a disciplined nonsurgical treatment regimen of 3 to 6 months’ duration, surgery is recommended. Figure 10 Traumatic injury to the lateral elbow. It was clinically diagnosed as medial epicondylitis and ultrasound shows changes of medial epicondylitis. Notice the small cystic changes (white arrow). 1, Orthopaedics & Traumatology: Surgery & Research, Vol. Levin et al (17) found a statistically significant relationship between clinical symptoms of lateral epicondylitis and US findings of intratendinous calcification, tendon thickening, bone irregularity, focal hypoechogenicity, and diffuse heterogeneity. 23, No. The common extensor tendon originates at the lateral epicondyle. Rupture of the LUCL may result in posterolateral rotatory instability, and surgical release of the extensor tendon may lead to further destabilization of the elbow (14). Figure 10 Traumatic injury to the lateral elbow. Then holes are drilled in the capitellum and the defects are filled with the autologous bone and cartilage. Notice that there is some marrow edema in the sublime tubercle. Pain is exacerbated with resisted forearm pronation and resisted wrist flexion. This image is of a 68 year old woman who injured her arm approximately 10 years previously and now presents with increasing pain in that arm. The control group consisted of 26 patients of similar age with no clinical evidence of medial epicondylitis. 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). Viewer Presentation. The LUCL should be carefully evaluated. However, abnormal changes in the flexor carpi ulnarisand palmaris longus origins at the elbow may also be present. (a) Coronal GRE MR image obtained in a 40-year-old woman demonstrates a full-thickness tear and retraction of the ECRB with adjacent edema (arrow). 33, No. Although it’s common for golfers and other athletes, anyone can get golfer’s elbow, especially if their jobs or hobbies require repetitive motions. Longitudinal US view of the common extensor tendon origin in a 59-year-old man shows a small linear hypoechoic region at the origin of the ECRB (arrow), a finding indicative of a small partial-thickness tear.Figure 13Download as PowerPointOpen in Image 3, 23 April 2012 | Therapeutic Advances in Musculoskeletal Disease, Vol. The cartilage is still intact. Longitudinal US image of the common extensor tendon origin in a 64-year-old man reveals a large hypoechoic region at the tendon origin, a finding indicative of a near-full-thickness tear. Coronal GRE MR image obtained in a 43-year-old man depicts a normal appearance of the MCL (arrow) at its insertion on the sublime tubercle of the ulna (*).Figure 21Download as PowerPointOpen in Image These images are of a 23 year old male who fell onto his outstretched hand two weeks ago while skateboarding. Posteriorly, the radial tunnel is delineated at its proximal end by the capitellum and at its distal end by the distal aspect of the supinator muscle. Coronal GRE MR image shows complete disruption of the MCL (black arrow) and a partial-thickness tear of the common flexor tendon at its undersurface (white arrow).Figure 26Download as PowerPointOpen in Image In these cases we usually ask for a comparison view, because it can be very subtle. However, with a confounding clinical picture or with refractory cases, imaging is recommended. A male presented with right elbow pain localized to the medial epicondyle. Figure 16 Intraoperative photograph, obtained during a modified Nirschl procedure for treatment of lateral epicondylitis, shows a portion of the torn ECRB tendon origin (arrow) within the forceps. Viewer The findings on the coronal MR-images are quite uncommon. Lateral ulnar collateral ligament Initial clinical management of medial epicondylitis involves cessation of the provocative activity, application of cold packs to the elbow, and oral NSAID therapy. It is one of the medial patellar stabilizers together with the medial retinaculum and the vastus medialis oblique muscle 5. Viewer Study design: Prospective cohort study. The ulnar nerve is located within the cubital tunnel and may be injured in association with medial epicondylitis from chronic stretching and irritation or from direct injury (9,11). It turned out to be rice bodies. As we go further posteriorly there is a small area of low signal intensity (yellow arrow), which is an avulsion of part of the UCL. 28, No. Epicondylitis causes pain and functional impairment and typically results from specific occupational and sports-related activities. On the sagittal images we were not sure about a possible tear. This is better appreciated on the radiograph. Medial epicondylitis (golfer’s elbow) is a type of tendinitis that affects the inside of the elbow. Figure 5a Normal LUCL and RCL. Case contributed by Dr Varun Babu. The Editor has no relevant financial relationships to disclose. Figure 8b Severe lateral epicondylitis. The flexor carpi radialis, palmaris longus, and flexor carpi ulnaris form the common flexor tendon. 10, Magnetic Resonance Imaging Clinics of North America, Vol. The degenerated portion of the tendon was subsequently excised, the flexor carpi radialis–pronator teres interval was closed, and the intact portion of the tendon was reattached to the medial epicondyle. Pain associated with medial epicondylitis often develops due to overuse of the forearm muscles that attach to the medial epicondyle. There is marrow edema in the medial epicondyle and also in the adjacent bone (yellow arrow). Notice the normal ulnar collateral ligament (red arrow). Originates just underneath the attachment of the common extensor tendon. In most patients, the condition is managed conservatively with cessation of the offending activity, applications of ice, administration of a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid injection, and use of a splint or brace (4,7). Clinical history: 40 year old male carpenter with lateral elbow pain. Now the nerve could be dislocated, but in this case the nerve was surgically transposed. Keywords: elbow anatomy, elbow imaging, MR arthrography, MRI, synovial fold. Google Scholar; 19 Trappeniers L, De Maeseneer M, Van Roy P, Chaskis C, Osteaux M. Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic … The UCL (in yellow) originates on the undersurface of the medial epicondyle just beneath the origin of the common flexor tendon. The authors thank Alissa J. Burge, MD, Department of Radiology, North Shore University Hospital, Manhasset, NY, for providing the medical illustrations. Now look at the MR-images and try to figure out if the tendon is retracted and whether there is a partial or complete tear... Well on the sagittal image it looks as if the tendon is completely thorn, but continue with the next images. Maneuvers such as the “chair test” (in which the patient is asked to lift a chair with a pronated hand) and the “coffee cup test” (in which the patient picks up a full cup of coffee) evoke focal pain at the lateral epicondyle (7). Plain radiograph of the elbow was unremarkable. Now here is the MR. On the sagittal image it is clear that it is only partial tearing. Nerve pathology can present as thickening of the nerve when there is neuritis or as a result of compression of the nerve. Attaches on the coronoid process. The fibers of the RCL course distally along the long axis of the radial head to blend with the fibers of the annular ligament. The medical records and MR imaging findings of these patients were retrospectively reviewed by two fellowship-trained musculoskeletal radiologists. The degenerated portions of the ECRB and the leading edge of the extensor digitorum brevis are then excised. Ofcourse the T2-fatsat images will show marrow abnormalities, but T1 can be helpful in telling us what is really going on. 4, Acta Orthopaedica et Traumatologica Turcica, Vol. Little Leaguer's Elbow. Lateral epicondylitis occurs with a frequency seven to ten times that of medial epicondylitis. The diagnosis of epicondylitis hinges on a careful history and physical examination. Golfer's elbow,often also called Medial Epicondylitisis defined as a pathologic condition that involves the pronator teresand flexor carpi radialisorigins at the medial epicondyle. On the sagittal image it is clear that it is only partial tearing. Figure 9 Severe lateral epicondylitis. The final diagnosis was cat scratch disease based on high Bartonella henselae titers. It is due of chronic stress to the common extensor tendon, which results in partial tearing and tendinosis. 2, 5 September 2015 | Rheumatology International, Vol. However regular weight training can result in symptoms appearing much earlier as was in this case. Lateral epicondylitis is caused by repeated contraction of the forearm extensor muscles, particularly at the origin of the ECRB, which results in microtearing with subsequent degeneration, immature repair, and tendinosis. T1In every joint that is studied you should have at least one T1-sequence not only to look at the anatomy, but also as a back up for looking at the marrow. Figure 17 Drawing shows the musculotendinous anatomy of the medial aspect of the elbow. The MCL is the ligament most commonly involved (11). Here an easy case, because the tendon is retracted as can be best seen on the sagittal image. Epicondylitis occurs due to damage to the tendons in the forearm. Usually it is the long head of the biceps that is completely torn. Attaches on the radial tuberosity. The study group consisted of 13 patients with clinically diagnosed medial epicondylitis. 8, No. Figure 31 Moderate medial epicondylitis. 11, 12 August 2016 | Current Radiology Reports, Vol. Viewer Axial T2-weighted fast SE MR image obtained in a 48-year-old man demonstrates prominent regions of intermediate to high signal intensity within the flexor digitorum superficialis (black arrow), flexor carpi radialis (white arrow), and pronator teres (arrowhead), findings indicative of muscle strain associated with medial epicondylitis.Figure 25Download as PowerPointOpen in Image 23, No. This is explained by changes of bilateral ulnar neuropathy ( edematous ulnar nerve in the cubital tunnel ). Epidemiology It is less common than lateral epicondylitis. 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