VPMRI consists of a fracture of the anteromedial coronoid facet and a rupture of the LCL complex. You may also get tendinitis from overuse of the elbow. It is deceptively one of the more technically demanding projections in radiography 1-3. The AL can be injured in the setting of trauma and after closed reduction of elbow dislocation (Figs. 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 (Fig. 12) [1]. Elbow dislocation is also classified as simple, without associated fracture, or complex, with an associated fracture. The A-MCL is best visualized on coronal and axial slices. MR imaging findings in acute LUCL injury resemble those described for the MCL: hyperintensity, discontinuity, and surrounding soft-tissue edema on conventional fluid-sensitive MR images (Figs. Coronal T1-weighted MRI (a) and coronal FS PD-weighted MRI (b) showing an acute proximal common avulsion of the lateral ulnar collateral ligament and radial collateral ligament (white arrows), an acute avulsion of the anterior bundle of the medial collateral ligament complex (white arrowheads), a radial head fracture (white asterisks), a partial tear of the proximal common extensor tendon (yellow arrows), and joint effusion, A 33-year-old female gymnast with elbow pain and instability. Goldfarb CA, Patterson JM, Sutter M et-al. Among iatrogenic causes of LCL complex disruption, we find overaggressive extensor tendon release for lateral epicondylitis, and radial head excision for comminuted fractures of the radial head [33, 34]. The use of short-tau inversion recovery for fat suppression or methods of fat/water separation can also be useful [4, 5]. In an axial view through the motion axis of the distal humerus, the ulnohumeral incongruity is the difference of the lowest and the highest values of four measures extending from the trochlear joint surface to the corresponding joint surface of the olecranon (Fig. Diagnosis is often difficult, as the clinical exam can be misleading unless performed under anesthesia. A report of three cases. The lateral epicondyle of the humerus is a large, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow joint, and to a tendon common to the origin of the supinator and some of the extensor muscles. The most important static soft-tissue constraints are the lateral ulnar collateral ligament and the anterior bundle of the medial collateral ligament [5, 7, 13]. Part I: normal anatomy, imaging technique, and osseous abnormalities. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The head articulates with the capitellum of the humerus and the radial notch of the ulna (Hansen et al., 2010, p. 312). Beltran LS, Bencardino JT, Beltran J (2013) Imaging of sports ligamentous injuries of the elbow. A better understanding of their anatomy and their relationship with adjacent structures is necessary to improve the detection of abnormalities. The docking technique (Figs. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. According to the Charalambous classification [38], type 3D and 4D DRHN fractures tended to have a higher association with MCL rupture compared with type 1D and 2D DRHN fractures, commonly associated with LUCL rupture, although this was not statistically significant [39]. In the case of the latter, an acute tear of the MCL may be encountered. Eur Radiol 23:2582–2593, Delport AG, Zoga AC (2012) MR and CT arthrography of the elbow. It represents a spectrum of pathology consisting of three stages depending on the grade of soft-tissue disruption, which extends from lateral to medial, the so-called circle of Hori [5, 7, 17] (Figs. However, the distal insertion of the A-MCL complex can normally be up to 3 mm distal to the articular cartilage, especially in older patients, simulating the “T-sign” [5, 14]. This is usually accompanied by a radial head fracture. Semin Musculoskelet Radiol 17:429–436, Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M (2010) Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. The LCL complex resists excessive varus and external rotational stress. Up to 40% of throwing athletes with MCL injuries and more than 50% with medial epicondylitis have ulnar neuropathy [22]. The RCL is a fan-shaped ligament that originates at the lateral epicondyle of the humerus and runs longitudinally underneath the common extensor tendon blending with the anterior annular ligament (Fig. 9 and 10), osteochondral impaction injuries to the radiocapitellar and ulnohumeral articular surfaces (Fig. et al. Because this bursa lies relatively superficially, it can also become infected (e.g cut from a fall on the elbow) PubMed Google Scholar. At first, the elbow seems like a simple hinge. The classification of elbow dislocations is based on the direction of dislocation: posterior, posterolateral, posteromedial, lateral, medial, or divergent. More often, it remains close to the parent bone, presenting on MRI with bone marrow edema and/or a widened gap between the medial epicondyle and the humerus (Fig. The use of manual shimming and manual prescan can often correct this problem. Part of Consecutive coronal FS T1-weighted direct MR arthrographic images (a–f) showing a proximal partial-thickness tear of the anterior bundle of the medial collateral ligament complex (short arrows), proximal complete tear of the lateral ulnar collateral (long white arrows), and partial-thickness tear of the radial collateral ligament proper (white arrowhead), Posterolateral rotatory instability, stage 3B. Two different patients with chronic elbow pain and medial instability. 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