Title: MRI of the Normal Elbow and Common Pathologic Conditions
Abstract: HomeRadioGraphicsVol. 40, No. 2 PreviousNext Musculoskeletal ImagingFree AccessRadioGraphics Fundamentals | Online PresentationMRI of the Normal Elbow and Common Pathologic ConditionsJosé Acosta Batlle , Luis Cerezal, Mercedes Vallejo Márquez, María D. López Parra, Carmen Soteras, Santiago Resano, Javier Blázquez SánchezJosé Acosta Batlle , Luis Cerezal, Mercedes Vallejo Márquez, María D. López Parra, Carmen Soteras, Santiago Resano, Javier Blázquez SánchezAuthor AffiliationsFrom the Department of Radiology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, Madrid, Spain, 28034 (J.A.B., M.D.L.P., C.S., S.R., J.B.S.); Department of Radiology, DMC-Diagnóstico Médico Cantabria, Santander, Spain (L.C.); and Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain (M.V.M.).Address correspondence to J.A.B. (e-mail: [email protected]).José Acosta Batlle Luis CerezalMercedes Vallejo MárquezMaría D. López ParraCarmen SoterasSantiago ResanoJavier Blázquez SánchezPublished Online:Mar 3 2020https://doi.org/10.1148/rg.2020190134MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.The elbow joint consists of three different articulations within a single synovial capsule: the ulnohumeral, radiocapitellar, and radioulnar joints. The first two function as a hinge, permitting flexion and extension. The last two joints accomplish the pivot motion of pronation and supination and are functionally linked to the distal radioulnar joint and the wrist.The stability of the elbow joint is dependent on the integrity of several osseous and soft-tissue structures. The anterior band of the ulnar or medial collateral ligament complex is the main static stabilizer of the elbow against valgus and internal rotation stress. The lateral collateral ligament complex resists excessive varus and external rotational stress. The lateral ulnar collateral ligament is the most important in terms of stability.Conventional MRI and MR arthrography are the imaging modalities of choice in the evaluation of elbow injuries. MRI of the elbow is best performed with a high-field-strength magnet, and it is essential to use surface coils. MR images are acquired using T1-weighted, T2-weighted, and proton density–weighted sequences, with and without fat suppression. The introduction of an isotropic three-dimensional imaging technique has shown promise in the visualization of anatomy and pathologic conditions of the elbow, as well as cartilage quantification.The collateral ligaments of the elbow are optimally visualized in a 20° posterior oblique coronal plane in relation to the humeral diaphysis with the elbow extended. The biceps insertion can be imaged with the elbow flexed, shoulder abducted, and forearm supinated (FABS position).MR arthrography of the elbow is helpful to evaluate intra-articular loose bodies, osteochondral and chondral lesions, capsular and ligamentous injuries, medial elbow pain in the throwing athlete, and elbow dislocations. Lateral and medial epicondylitis usually results from repetitive mechanical overload during occupational or athletic activities. This repetitive overuse results in tendinosis, which may progress to partial or complete rupture. Ulnar neuropathy is associated with medial epicondylitis in approximately 50% of patients.Distal biceps tendon ruptures are rare injuries that typically occur in the dominant arm of men aged 40 to 60 years, especially among manual workers and weight lifters. Elbow dislocations are frequent. Approximately 35%–45% of acute dislocations result in chronic instability. Chronic instability of the elbow can be classified into three main types: medial, lateral, and longitudinal instability.Posterolateral rotatory instability is the most common pattern of recurrent elbow instability (Fig 1). The typical mechanism of injury is a fall with the hand extended and the shoulder abducted. Chronic medial instability can be caused by trauma or overuse. Osteochondral lesions of the elbow usually occur on the anterior aspect of the humeral condyle and occur more frequently in young athletes owing to mechanical overload with valgus stress (Fig 2).Figure 1. Axial illustrations of the elbow in a superior view show the progression of injury (dark gray lines) in a case of posterolateral rotatory instability. LUCL = lateral ulnar collateral ligament, MCL = medial collateral ligament, RCL = radial collateral ligament proper.Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Coronal illustrations of the elbow show various injuries (gray areas) to the anterior bundle of the medial collateral ligament (MCL) owing to repeated valgus stress in an athlete who participates in overhead throwing sports: A, normal findings; B, C, microtears; and D, partial tears.Figure 2.Download as PowerPointOpen in Image Viewer Panner disease is a self-limited condition of the entire capitellum that manifests in childhood before ossification of the capitellum is complete. The articular surface remains intact.In the online presentation, the normal anatomy and common pathologic conditions of the elbow joint are reviewed, as well as the spectrum of MRI findings and key technical aspects that can optimize imaging.Presented as an education exhibit at the 2018 RSNA Annual Meeting.All authors have disclosed no relevant relationships.Suggested ReadingsAcosta Batlle J, Cerezal L, López Parra MD, Alba B, Resano S, Blázquez Sánchez J. The elbow: review of anatomy and common collateral ligament complex pathology using MRI. Insights Imaging 2019;10(1):43. Crossref, Medline, Google ScholarBinaghi D. MR Imaging of the elbow. Magn Reson Imaging Clin N Am 2015;23(3):427–440. Crossref, Medline, Google ScholarBucknor MD, Stevens KJ, Steinbach LS. Elbow imaging in sport: sports imaging series. Radiology 2016;279(1):12–28. Link, Google ScholarCerezal L, Studer A, Carro LP, Villalba A. Postoperative elbow imaging. In: Sutter R, ed. MRI of the elbow. Horn, Austria: Breitenseher, 2018; 95–116. Google ScholarDelgado J, Jaramillo D, Chauvin NA. Imaging the injured pediatric athlete: upper extremity. RadioGraphics 2016;36(6):1672–1687. Link, Google ScholarFrick MA, Murthy NS. Imaging of the elbow: muscle and tendon injuries. Semin Musculoskelet Radiol 2010;14(4):430–437. Crossref, Medline, Google ScholarHowe BM, Spinner RJ, Felmlee JP, Amrami KK. High-resolution imaging of upper limb neuropathies. Semin Musculoskelet Radiol 2015;19(2):160–167. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 28 2019Revision requested: Sept 16 2019Revision received: Oct 8 2019Accepted: Oct 16 2019Published online: Mar 03 2020Published in print: Mar 2020 FiguresReferencesRelatedDetailsCited ByMusculoskeletal Radiology for ResidentsPawelSzaro2022Radiopaedia.orgLeoMartinez2022How to Report: Elbow MRIJames FrancisGriffith2021 | Seminars in Musculoskeletal Radiology, Vol. 25, No. 05IDKD Springer SeriesMark W.Anderson, Christine B.Chung2021Radiopaedia.orgHenryKnipe, JoachimFeger2020Radiopaedia.orgHenryKnipe, YurangaWeerakkody2010Accompanying This ArticleMRI of the Normal Elbow and Common Pathologic ConditionsMar 3 2020Default Digital Object SeriesRecommended Articles Elbow Imaging in Sport: Sports Imaging SeriesRadiology2016Volume: 279Issue: 1pp. 12-28Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball PlayersRadiology2016Volume: 279Issue: 3pp. 827-837Imaging the Injured Pediatric Athlete: Upper ExtremityRadioGraphics2016Volume: 36Issue: 6pp. 1672-1687Twin Robotic Gantry-Free Cone-Beam CT in Acute Elbow TraumaRadiology2022Volume: 306Issue: 3Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging SeriesRadiology2016Volume: 279Issue: 3pp. 674-692See More RSNA Education Exhibits Ultrasound of Medial Elbow Pain: Beyond the EpicondylitisDigital Posters2022Pitch Perfect: Biomechanics and Patterns of Injury In the Throwing ArmDigital Posters2022A Comprehensive Imaging Review Of Elbow Injuries In The Emergency DepartmentDigital Posters2021 RSNA Case Collection Medial epicondylar fracture with internal joint entrapmentRSNA Case Collection2022Radial Head FractureRSNA Case Collection2021Transient patellar dislocationRSNA Case Collection2020 Vol. 40, No. 2 Slide PresentationMetrics Altmetric Score PDF download