MRI of the elbow joint.

Dr/ ABD ALLAH NAZEER. MD

Imaging of the Elbow Joint

AP view Lateral view

MRI technique

Anatomy and Pitfalls

http://www.radiologyassistant.nl/data/bin/a522c7013cae72_2-Ill-anatomy.jpg

Ulnar nerve

MR anatomy of the elbow joint

Normal distal biceps tendon . At conventional MR images, longitudinal viewsare difficult to obtain because of the oblique course of the tendon (arrows). MR imagesobtained with the patient in the FABS position shows a normal distal biceps tendon (openarrows), the musculotendinous junction (open arrowhead), and the radial tuberosity (solidarrowhead).

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.

Lateral epicondylitis.

Partial tear Complete tear

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).

Medial Epicondylitis

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

Ulnar neuritis

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.PathologyCauses osteochondritis dissecans thought to be due to repeated microtraumaavascular necrosismacrotraumapost surgical

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 joint Swelling.

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 elbow joint.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 shoulder.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 injured joint.

MRI showed intraarticular fluid and a fibrous intraarticular pannus in rheumatoid arthritis.

Soft tissue masses about the elbow joint.

Median nerve schwanoma.

Thank You.