0:00

If you remember, this is the same patient

0:02

that we performed an arthrogram on, and also the same patient who,

0:06

a few months ago,

0:07

had this osteochondral lesion in the capitellum. Right over here.

0:12

But continued to have pain despite conservative management.

0:16

So we did the arthrogram, and we're looking at the elbow again.

0:20

What do we see?

0:21

So this, on your image on your left, is a fat-suppressed fluid-sensitive sequence.

0:25

This one is a T1 fat-suppressed image.

0:28

All the bright signal you see here is gadolinium.

0:31

It's not liquid that's lighting up because it's a T1-weighted sequence.

0:34

So this is T1 shortening effect, showing gadolinium in the joint.

0:37

What do we notice here that we didn't notice on the prior imaging?

0:42

Well, we see that there's new development

0:44

of edema in the capitellum, here, that wasn't there before.

0:48

And this is one of the sort of hallmarks of joint incongruity that happens.

0:54

So basically,

0:54

when you had this osteochondral lesion, it caused an incongruous joint.

0:59

Now, the weight bearing surfaces,

1:01

the way that one bone interacts with another bone, where the one articulate

1:05

surface interacts with another articulate surface, it's all out of whack.

1:09

Because of that, the way the capitellum

1:11

and the radial head interact is different.

1:13

So now you have edema and you're developing an osteochondral lesion

1:19

also in the capitellum. That probably stems from the fact that

1:23

there was joint incongruity from the first osteochondral lesion.

1:26

What does the T1-weighted image get us with arthrogram?

1:30

Well, it lets us look at associated injuries.

1:33

Oftentimes, these are throwing athletes, they're stressing their elbow,

1:36

maybe there's collateral ligament injuries.

1:38

There are loose bodies.

1:39

And as I look at this, I really closely evaluate the structure right here.

1:44

This is the anterior band of the ulnar collateral ligament,

1:47

and it's nice and very intimately associated with the sublime tubercle.

1:54

That's got to be one of my favorite terms in anatomy, sublime tubercle.

1:58

Okay, so it's nice and intimately associated.

2:01

That's fine.

2:01

But as we look through this, what do we notice?

2:04

Aha!

2:05

What is this?

2:06

See that was not there on the prior imaging.

2:09

Maybe it was there and the intra articular contrast just revealed it

2:13

because now we have bright signal all the way around it.

2:15

But there's also a loose body in this patient.

2:18

So, you've got three things wrong.

2:21

You've got the initial osteochondral lesion

2:23

in the lateral aspect of the trochlea.

2:25

You have a developing osteochondral lesion

2:28

with edema in the capitellum, and you have a tiny loose body at the very

2:35

periphery of the radial head capitellum joint.

2:39

Thankfully, nothing is wrong on the ulnar side,

2:41

and the anterior band of the ulnar collateral ligament is intact.

2:45

The radial collateral ligament, incidentally, is also intact.