Case Challenge

Elbow & Forearm

Stephen J Pomeranz

Gain confidence interpreting Elbow MRI with practice cases from MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

X-Ray (Plain Films)

Case Review

Musculoskeletal (MSK)

Post-Course Activities

This Power Pack is comprised of 25 unique Elbow MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Elbow MRI Cases

Case 16 - 33-year-old male presents with hyperextension injury of left elbow

<div>HISTORY:&#160;This 33-year-old male presents with hyperextension injury of left elbow after falling on outstretched arm.(QUIZ ANSWER) FINDINGS IN THIS CASE:&#160;All of the above.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: High grade insertional interstitial tear of the brachialis tendon with complex rupture at the myotendinous junction involving greater than 50% of the deep fibers. Biceps tendon and lacertus fibrosus intact. Deep approximately 1cm hematoma involves brachialis. Radial and median nerves intact.&#160;Lateral and medial heads triceps demonstrate low grade strains. Swelling in the cubital tunnel displaces medially the traversing ulnar nerve which is itself swollen. Posttraumatic 1.8 x 0.7cm olecranon bursitis.&#160;Limited evaluation of the proximal ulnar collateral ligament; however, low grade strain suggested. Medial epicondyle intact. High grade common flexor tear with greater than 1.5cm gap and associated hemorrhage. Pronator teres intact.&#160;Complete tear involves the radial collateral ligament. Focal anterior full thickness tear of the annular ligament. 1.5cm full thickness mid fiber tear of the lateral collateral ligament. Complete tear of the lateral ulnar collateral ligament. Lateral capsule disruption extends to the anterior capsule. High grade split tear measuring 4cm at the common extensor origin.&#160;Coronoid process intact. 11mm displaced osteochondral defect from the posterolateral capitellum (Osborne-Cotterill lesion). Subcortical osteoedema involves the lateral radial head without macrofracture. Normal radiocapitellar alignment.&#160;Moderate hemarthrosis with extravasation.&#160;CONCLUSION:&#160;1. Massive sequela from acute varus dislocation of the elbow.&#160;a. High grade, complex tear at the deep and myotendinous fibers of the brachialis with approximately 1cm intramuscular hematoma.&#160;b. Complete disruption of all layers of the lateral collateral ligamentous complex including the radial collateral ligament, annular ligament, lateral collateral ligament proper and lateral ulnar collateral ligaments and anterior capsule.&#160;c. 11mm osteochondral fragment with a secondary smaller ossific fragment posterolateral capitellum donor site and associated hemarthrosis.&#160;d. High grade split tear common extensor tendon.&#160;e. Intrinsic ulnar nerve swelling and extrinsic edema displaces the ulnar nerve medially. Clinical correlation for ulnar entrapment neuropathy recommended.&#160;2. Other findings as above.</div>

Case

High grade, complex tear at the deep and myotendinous fibers of the brachialis

Complete disruption of all layers of lateral collateral ligamentous complex (including radial collateral ligament, annular ligament, lateral collateral ligament proper, lateral ulnar collateral ligaments, and anterior capsule)

High grade split tear common extensor tendon

Which of the following findings can be seen in this case?