Elbow – Osteoarthritis

CASE HISTORY

65-year-old male who fell and injured elbow 3+ weeks ago with popping grinding posterior pain and limited range of motion. Diagnosis of osteoarthritis and loose body in elbow.

TECHNICAL FACTORS

Axial T1 T2 and T2 fat-sat sagittal T2 and coronal T1 T2 fat-sat and 3D gradient-echo sequences were performed through the left elbow without contrast administration.

KEY IMAGES

This case has no key images.

CASE FINDINGS

• Severe elbow osteoarthritis is present with multifocal moderate to large elbow spurs diffuse chondral thinning and/or loss and multiple scattered tiny subchondral cysts and areas of adjacent subchondral arthropathic bone marrow edema/fibrovascular reaction. 
• A large 2.6cm transverse by 1.6cm craniocaudal by 1.2cm AP peripherally corticated ossification is present within the anterior aspect of the elbow joint abutting the coronoid process of the ulna and a smaller 1.2cm in greatest diameter peripherally corticated ossification is present anteroinferior to this ossification (sagittal T2 series and coronal 3D gradient-echo series). On the coronal images these ossifications appear to be contiguous with the adjacent coronoid process of the ulna with similar size and contour making these highly concerning for chronic ununited coronoid process fracture fragments although large intraarticular loose bodies could potentially also have this appearance.
• Much smaller/more subtle intraarticular loose bodies are present more proximally within the coronoid recess of the elbow joint with one visualized on sagittal T2 series and axial T2 series  and one within the proximal most aspect of the coronoid recess appreciable on sagittal T2 series  and axial T2 fat-sat series. 
• A small associated elbow effusion is present. 
• A thin cortical avulsion fracture of the distalaspect of the lateral epicondyle at the attachment of the radial collateral ligament and distal aspect of the common extensor tendon origin is present with adjacent bone marrow edema highly concerning for an acute or subacute avulsion fracture. This is appreciable on coronal gradient-echo series  and on coronal T2 fat-sat and T1 series. The adjacent proximal aspect of the radial collateral ligamentous complex is sprained. The ulnar collateral ligamentous complex is intact. 
• The common extensor and common flexor tendons biceps brachialis and triceps tendons are intact. No evidence of an acute muscular strain.

CASE CONCLUSION

• A thin cortical avulsion fracture along of the distal aspect of the lateral epicondyle at the attachment of the radial collateral ligament and adjacent distal most aspect of the common extensor tendon origin is present with adjacent bone marrow edema highly concerning for an acute or subacute avulsion fracture fragment. The adjacent radial collateral ligamentous complex is sprained. Stretched well developed lateral ulnar collateral ligament eg. LUCL. 
• Severe elbow osteoarthritis as detailed above. 
• A large 2.6cm in greatest diameter peripherally corticated ossification and a smaller 1.2cm in greatest diameter peripherally corticated ossification are present within the anterior elbow joint along the anterior aspect of the coronoid process of the ulna which are highly concerning for chronic ununited fracture fragments of the coronoid process of the ulna (as detailed above) although osseous loose bodies (in this patient with severe elbow osteoarthritis) could potentially also have this appearance. Subtle/smaller osseous loose bodies are also present more proximally within the coronoid recess of the elbow joint. 
• Small elbow effusion.