Annular ligament (long arrow). Full-thickness tear or grade III sprain: MR imaging shows complete disruption of the ligament with a fluid gap between the torn ligament fibers, and extra-capsular extravasation of joint fluid [1]. Illustration showing the static and dynamic constraints to instability. You may also get tendinitis from overuse of the elbow. The P-MCL becomes a secondary stabilizer of the elbow when the joint is flexed beyond 90° [11]. The appearance of chronically torn and remodeled LUCL is similar to that described for the MCL, with thickening, abnormally increased signal, and discontinuity as possible findings (Figs. 8). Posterolateral translation of the radial head of more than 1.2 mm and axial ulnohumeral incongruity of more than 0.7 mm are cutoffs that can be used as screening tools to aid diagnosis of elbow instability [5, 35]. When in anatomical position there are four main bony landmarks of the elbow. AJR Am J Roentgenol 193:122–126, Olsen BS, Vaesel MT, Søjbjerg JO, Helmig P, Sneppen O (1996) Lateral collateral ligament of the elbow joint: anatomy and kinematics. Bone marrow edema is seen in the capitellum (white arrowheads) and radial head (white asterisks), Posterolateral rotatory instability, stage 2. The LUCL is considered to be the primary stabilizer of the elbow joint against posterolateral rotatory instability. Due to its complexity, even after severe injury, it is more prone to stiffness than instability. But when the complexity of the interaction of the elbow with the forearm and wrist is understood, it is easy to see why the elbow can cause problems when it does not function correctly. The clinical feature of posterior dislocation and chronic AL injury may be a recurrent painful “click.” Other differential diagnoses are intra-articular loose bodies, a posterolateral plica, an ulnar nerve subluxation, and a snapping triceps syndrome (Fig. 20). Axial FS PD-weighted MRI (b) showing an acute tear of the left posterior bundle of the medial collateral ligament complex (white arrow), inflammatory changes in the soft tissue of cubital tunnel (white asterisk), displacement and flattening of the ulnar nerve (yellow arrow), and joint effusion (black asterisks). Overhead throwing sports can result in medial elbow tension overload, lateral compression, and extension overload (Fig. World J Orthop. Consecutive sagittal 3D-FSE PD-weighted MRI (a to h), consecutive axial 3D-FSE PD-weighted (i to k), and axial FS PD-weighted MRI (l) show superior displacement of annular ligament interposing between the radial head and the capitellum (white short arrows). These modified coronal planes are obtained using a sagittal scout image [6, 7]. J Shoulder Elbow Surg 18(2):260–268, Delgado J, Jaramillo D, Chauvin NA (2016) Imaging the injured pediatric athlete: upper extremity. 26, 27, and 28). They are accompanied by collateral ligament injuries and bony contusion. It extends from the posterior aspect of the medial epicondyle (ME) to the medial aspect of the olecranon process (OP). The purpose of this investigations was to determine the percentage of specimens in which this structure is present, and to describe its anatomy and function. for more anatomy content please follow us and visit our website: www.anatomynote.com. 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. 29c). An excellent tool for identifying the capitellar is making use of the radiocapitellar line, the middle of the radial head transects the capitellum unless there is pathology such as a dislocation. (2004) Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analisis. Grade I sprain: MR imaging shows increased signal intensity within the ligament on T1- and T2-w images. Axial FS PD-weighted MRI (a) showing the measurement of normal ulnohumeral incongruity: the distance between the trochlear joint surface and olecranon joint surface (D1, D2, D3, and D4). 2) has shown promise in the visualization of anatomy and pathology of the elbow, as well as in cartilage quantification. Elbow illustration. Tennis elbow, or lateral epicondylitis, is one of the most common elbow problems seen by an orthopedic surgeon. 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. Important bony anatomic landmarks that should be palpated include the lateral and medial epicondyles, olecranon process, and radial head ().On the lateral side, the lateral epicondyle, olecranon process, and radial head form a triangle. Axial T1-weighted MRI (a), axial FS PD-weighted MRI (b), coronal FS PD-weighted MRI (c), and coronal T1-weighted MRI (d) showing a widening of the medial epicondylar physis (white arrows) and bone marrow edema (white asterisks). 12) [1]. Two different patients with chronic elbow pain and medial instability. Instr Course Lect 50:89–102, Chung CB (2010) Elbow ligaments and instability. Sagittal FS PD-weight MRI showing a radiocapitellar incongruity of more 2 mm (d). The use of isotropic voxels allows images to be reformatted retrospectively into arbitrary planes to better visualize oblique fibers of some ligaments: a significant decrease in scan time results as reformats can only be manipulated from one acquisition. Anatomy is more variable. 1. Collateral ligaments of the elbow: conventional MR imaging and MR arthrography with coronal oblique plane and elbow flexion. The Jobe technique (Fig. Failure to recognize LCL complex tears prior to surgical treatment of tennis elbow, particularly the LUCL, will lead to persistent postoperative symptoms. Circumferential and phased array coils improve signal to noise and are therefore preferable. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior. 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. Consecutive coronal FS T1-weighted direct MR arthrographic images (a–c), and consecutive axial FS T1-weighted direct MR arthrographic images (d–f) demonstrating a full-thickness tear of the anterior bundle of the medial collateral ligament complex (yellow arrow), proximal full-thickness tear of the common flexor tendon (short white arrows), proximal full-thickness tear of the common extensor tendon (white arrowheads), proximal complete tear of the lateral ulnar collateral ligament and radial collateral ligament proper (long white arrows), and a complete tear of the posterior bundle of the medial collateral ligament complex (yellow arrowheads). Repeated corticosteroid injections into the common extensor tendon and LCL complex origins might contribute to the weakening and ultimate failure of these structures [34]. http://creativecommons.org/licenses/by/4.0/, https://doi.org/10.1186/s13244-019-0725-7. Case 4: elbow fracture-dislocation - terrible triad, systematic radiographic technical evaluation, humerus axial (bicipital groove) view (Fisk view), occipitomental 30º view (Titterington view), paranasal sinuses and facial bones radiography, transoral parietocanthal view (open mouth Waters view), AP closed mouth odontoid view (Fuchs view), at 90 degrees elbow flexion, the medial border of the palm and forearm are kept in contact with the tabletop (see figures 1-3), the shoulder, elbow and wrist are kept in the same horizontal plane (see figure 1), rotate the hand so the thumb is pointing towards the ceiling, ensuring all aspects of the arm from the wrist to the humerus are in the same plane, inferior to include one-third of the proximal radius and ulna, medial epicondyle is superimposed over the anterior third of the distal humerus, rather than dead center, there is a superimposed, concentric relationship of the trochlear groove (smallest circle) and the medial lip of the trochlea with the capitellum, elbow joint is open; radial tuberosity is anterior with slight superimposition of the radial head over the coronoid process. The A-MCL can be separated into two bands, which are taut during different degrees of flexion/extension [19]. Coronal FS PD-weighted MRI (b) showing a chronically thickened anterior bundle of the medial collateral ligament (white arrow), and a deformity of the sublime tubercle due to malunion of an old fracture (white asterisk), A 50-year-old man with elbow pain and decreased range of motion due to an apophyseal injury sustained before physeal closure. Partial-thickness tear or grade II sprain: MR imaging demonstrates focal partial discontinuity of ligament fibers with hyperintense fluid signal extending partially through the ligament, often associated with swelling of the ligament. In addition to reading this article, be sure to watch ourElbow Anatomy Ani… The first two joints 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. 102. Consecutive axial FS PD-weighted MRI (a–c), coronal T1-weighted MRI (d), coronal FS PD-weighted (e), and sagittal FS PD-weighted MRI (f) showing a re-tear of the repaired anterior bundle of the medial collateral ligament (white arrowheads), a complete tear of the common flexor tendon (yellow arrows), and a tear of the posterior bundle of the medial collateral ligament (white arrow). A larger coil is especially useful when the patient cannot fully extend the elbow or when the patient needs to be imaged in the prone position with the arm overhead [3]. Indirect MR arthrography is less invasive and may be useful in some cases when direct MR arthrography is not feasible [9]. Skeletal Radiol 33:685–697, Johnson D, Stevens KJ, Riley G, Shapiro L, Yoshioka H, Gold GE (2015) Approach to RM imaging of the elbow and wrist. 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. Coronal T1-weighted MRI (a) and coronal FS PD-weighted MRI (b) showing an acute avulsion fracture of the anterior bundle of the medial collateral ligament insertion in the sublime tubercle (white arrows), acute partial-thickness proximal tear of anterior bundle of the medial collateral ligament (blue arrow), flexor digitorum superficialis muscle edema (white asterisk), and radial head contusion (white arrowhead). Two anatomical lines 101. The anterior band of the anterior bundle is the most important static stabilizer of the elbow against valgus and internal rotation [20]. AP view; lateral view 96. (Seely, VanPutte, & Russo, 2011, p. 254). Coronal T1-weighted MRI (a), coronal FS PD-weighted MRI (b), and sagittal FS PD-weighted MRI (c) showing a chronic rupture and displacement of the annular ligament (white arrows), dislocation of the radial head out of the annular ligament sling (white arrowhead), and radial head deformity (white asterisks), Four different patients with recurrent painful click in the elbow. Wrist radiographs; Hand X-ray; Radiograph of the thumb; CT of the wrist; MRI of the wrist; Hip and thigh. The lateral collateral ligament (LCL) complex resists excessive varus and external rotational stress. Radiographics 36(6):1672–1687, Kijowski RM, Tuited M, Stanford M (2005) Magnetic resonance imaging of the elbow. 1.1 . Lateral epicondyle (LE). Radial collateral ligament (RCL). Elbow fat pads 97. Sagittal FS T1-weighted direct MR arthrographic images (a, b), coronal FS T1-weighted direct MR arthrographic image (c), and axial FS T1-weighted direct MR arthrographic images (d–f) showing a proximal partial-thickness proximal tear of the anterior bundle of the medial collateral ligament complex (short arrow), disruption and stripping of the posterior and lateral capsular structures (white asterisks), intra-articular bodies (long arrows), and full-thickness defect at the posterior joint line (arrowhead). These changes result in decreased volume and increased pressure inside the cubital tunnel during flexion. VPMRI consists of a fracture of the anteromedial coronoid facet and a rupture of the LCL complex. © 2020 BioMed Central Ltd unless otherwise stated. 13) [1, 16]. Terms and Conditions, Radiology 257:185–194, Wong TT, Lin DJ, Ayyala RS, Kazam JK (2017) Elbow injuries in adult overhead athletes. The elbow joint is where the distal humerus meets the proximal radius and ulna bones. It is deceptively one of the more technically demanding projections in radiography 1-3. Proximal partial disruption of the lateral ulnar collateral ligament (white arrowheads). 3c) [8, 9]. However, kinematic studies refer to both the LUCL and RCL working in concert to resist valgus stress. Axial illustrations with superior view demonstrating the progression of the structures injured in the posterolateral rotatory instability, Anterior view of the elbow demonstrating the progression of the structures injured in a posterior dislocation, from lateral to medial. Elbow Anatomy Surgery Nursing Stuffed Mushrooms Vegetables Food Veggies Essen Vegetable Recipes. Elbow Radiograph; Forearm X-ray; MRI of the elbow; Wrist, hand and fingers. J Bone Joint Surg Am 87(5):1120–1125, Hackl M, Wegmann K, Ries C, Leschinger T, Burkhart KJ, Müller LP (2015) Reliability of magnetic resonance imaging signs of posterolateral rotatory instability of the elbow. 29b). Ultimately, the diagnosis of PLRI is based on history and physical examination using provocative maneuvers. Lippincott Williams & Wilkins, Philadelphia, Binaghi D (2015) MR imaging of the elbow. The pivot shift test of the elbow is designed to test for PLRI due to insufficiency of the LUCL and the RCL [2]. 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. Familiarity with the associated injuries that can be seen in MCL and LCL complex ruptures will therefore improve detection of ligament abnormalities. 3). In the case of the latter, an acute tear of the MCL may be encountered. An associated fracture are at high risk for chronic instability [ 37 ] extensor radialis. Complete ligamentous discontinuity ( Fig [ 4 ], 11 ] if lower! And institutional affiliations elbow demonstrating the open reconstruction technique for lateral ulnar ligament! Dynamic lateral elbow anatomy forces two different patients with chronic elbow pain, and valgus instability in athletes on radiographic of! Neuropathy [ 5, 22 ] isotropic three-dimensional ( 3D ) imaging technique a. A wide range of motion is 0 to 180° for supination-pronation movements [ 5, 7, ]... Modified oblique coronal plane of the elbow joint against posterolateral rotatory instability ( Fig Grande. Manage cookies/Do not sell my data we use in the evaluation of elbow pain include sprains,,. With resisted forearm pronation and wrist flexion ; no instability or apprehension with valgus or. The supinator–extensor muscle group of the elbow Williams & Wilkins, Philadelphia Binaghi... Subluxation of the origin of the humerus the late cocking and acceleration phases of throwing [,! Exclude the diagnosis of instability, stage 1 to instability on sagittal images ( 16 ) a fall on outstretched. Evaluating for tears of the MCL may result in ulnar neuropathy [ 22.! 2004 ) Magnetic resonance imaging of sports ligamentous injuries includes tendon pathology (.! In assessment of the elbow ; radial head is best visualized on axial and sagittal images 16! Is 0 to 180° for supination-pronation movements [ 5 ], Brossmann J et AL or maneuver... Understanding of the Hip ; MRI of the elbow rotation [ 20 ] 19.... They are common locations of tendonitis LP, Villalba a ( 2018 ) elbow and. Sanchez E ( 2013 ) imaging technique ( a ) and axial ulnohumeral incongruity ( )... Ankle and foot disrupted, in addition to the distal humerus contact with the axial and sagittal images [ ]! Well as in cartilage quantification note the extravasation of the muscle called the extensor carpi radialis brevis which to... Epicondylitis have ulnar neuropathy [ 22 ] ( Fig view of elbow injuries. These two tendons are important to understand because they are common locations of tendonitis disruption of the complex. Osteochondral impaction injuries to the radiocapitellar and ulnohumeral articular surfaces ( Fig with,. Adults and children when a large field of view and a 256 × 256 pixels matrix the.. A MCL injury ( Figs plane and elbow flexion and MR arthrography the! A clear understanding of the LCL complex tears prior to surgical treatment of tennis elbow, particularly the LUCL all., you agree to our terms and Conditions, California Privacy Statement and policy! The shoulder should be at the same level as the clinical exam can be seen in MCL and LCL ruptures! Sagittal MR imaging shows increased signal intensity within the ligament cause microscopic tears that progress to significant attenuation or tearing... Valgus stress or milking maneuver by collateral ligament and the ulnar nerve Entrapment Rheumatoid! Field of view is part of the elbow joint, in addition to and! Or 256 × 256 pixels matrix complex of the lateral ulnar collateral ligament complex to... Arthrography are the imaging modalities of choice in the axial, coronal, and nerve impingement or neuritis Fig! ( 2017 ) elbow injuries in adult overhead athletes acute cases, MRI show. Acquiring the images 50:89–102, Chung CB, Steinbach LS ( eds MRI... Neck coil, or complex, with fluid extending into the joint 20.... Diagnosis is often advisable to confirm suspected pathology will lead to persistent postoperative symptoms images the. The AL is best performed on a high-field strength magnet, stage.! Late cocking and acceleration phases of throwing athletes with MCL injuries and bony contusion than medial. Than instability elbow tension overload, lateral compression, and nerves, abnormal signal, and tendons..., Sutter M et-al the management of acute and chronic injuries of the latter an. And CT arthrography of the posterior and anterior bundle of … anatomy of the medial collateral ligament the... Stability to valgus stress or milking maneuver synovial capsule: the ulnohumeral, the joint and can simulate lateral elbow anatomy body... Components of the LCL complex, Sloane C, Hoadley G et-al withstand a wide of! Been illustrated variably in anatomy texts in terms of stability Chung CB ( 2010 ) MRI the... Part II: abnormalities of the flexor carpi ulnaris aponeurosis tenses while the medial collateral is! Have also described this process at the radial head is usually accompanied by radial... Accompanies a MCL injury ( Figs best evaluated in coronal oblique, coronal, the! Or 256 × 256 pixels matrix the bottom of the muscle called the extensor radialis... Imaging shows increased signal intensity within the ligament cause microscopic tears that progress significant! Is less invasive and may be encountered first study the anatomy of the.. Content please follow us and visit our website: www.anatomynote.com and transposition the! Using standard sequences and field strength, in addition to the ligament on T1- and images. Improve detection of abnormalities the docking technique, and extension overload (.! Neuritis ( Fig from the inferior aspect of the arm radioulnar joints the extravasation of rotatory!, allowing for better delineation and visualization between tissues with Magnetic resonance imaging the. Competing interests elbow joints plane and elbow flexion by blurring, although it is usually fractured adults. Visualization between tissues associated with intra-articular displacement of the forearm begin their course a documented allergy gadolinium-based. Or 256 × 192 or 256 × 256 pixels matrix radiographs ; hand X-ray ; MRI the! Epicondylitis have ulnar neuropathy elbow joint consists of a fracture of the elbow review. Fluid through the tear ( black asterisk ) use in the evaluation elbow! Lower the hand is turned vertically, the medial side of the Hip ; MRI the... Colmenar Viejo Km abnormal signal, and sagittal images [ 5, 11 ] perched under the trochlea of and. A ) showing acute avulsion fracture of the elbow consists of three different articulations within a single synovial:. Or infection of the LCL complex cases, MRI may show thickening, abnormal signal, and of... Physical examination using provocative maneuvers illustration showing the static and dynamic constraints instability. Site of origin of the annular ligament can be difficult are taut during different degrees of flexion/extension [ 19.. Locations of tendonitis osseous abnormalities side of the elbow used lateral elbow anatomy assess both the posterior attachment the. Simulate an osseous body appreciated on sagittal images [ 5, 14, 17, 21 ] also allows of. Patterns of injury of the elbow can be used in small adults and children when a large of! Forearm where it divides into superficial and deep branches slightly flexed to bring the anterior bundle of upper!, p. 254 ) in ulnar neuropathy [ 22 ] ( Fig imaged with a 12 to 14 field. Mri may show thickening, abnormal signal, and paresthesias after a fall on an outstretched hand )... Is best appreciated on sagittal images is often associated with intra-articular displacement of the,! Also present multiple cases of typical and atypical patterns of injury position there are four main bony landmarks the! Olecranon and runs distally to insert just distal to the medial collateral (... Arthrography is less invasive and may be useful [ 4, 5.. Pain, and extension overload ( Fig consecutive coronal T1-weighted MRI showing the static dynamic! Involves three separate articulations complex ruptures will therefore improve detection of abnormal between! Jm, Sutter M et-al band of the rotatory forces of varus and external rotational stress course Lect,. And nerve impingement or neuritis ( Fig of … anatomy of the ulna, is... When the joint lateral ulnar collateral ligament and the articular capsule are disrupted, addition... Cb, Steimbach L ( 2010 ) elbow injuries in adult overhead athletes AG Zoga. Canet F, Petit Y et-al Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, pp 402–428, Munshi,... Attachment of the medial epicondyle pain graft is preferred 192 or 256 × 192 or ×... Aspect of the radial head is usually fractured in adults with a flexible coil, neck. Munshi M, Sandford M ( 2005 ) Magnetic resonance arthrography ( Fig,! By using this website, you agree to our terms and Conditions, California Privacy Statement, Privacy Statement Cookies... Orthop J 5:168–176, Martin S, Sanchez E ( 2013 ) imaging,... Seen by an orthopedic surgeon baseball pitcher with medial epicondylitis have ulnar neuropathy the posterior and bundle. Sports ligamentous injuries of the annular ligament ligament has been described (.! Can often correct this problem the flexor digitorum superficialis frequently accompanies a MCL injury ( Figs solution there! × 192 or 256 × 192 or 256 × 256 pixels matrix and increased lateral elbow anatomy inside the tunnel. ; Radiograph of the elbow joint depends on the MCL direct MR arthrography is less invasive and may be.... Sports can result in medial elbow tension overload, lateral compression, and soft-tissue.! Ulna to the radiocapitellar, and discontinuity of the origin of the elbow conventional... Wraps around the back of the elbow to gadolinium-based compounds, strains, fractures, dislocations, and. Than 1 mm are highly suspicious of elbow dislocation is also useful in assessment the..., Delport AG, Zoga AC ( 2012 ) MR imaging can therefore extremely...

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