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Starting again with the theme of cartilage and cartilage injuries.

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Let's move on to osteochondral lesions or

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OCDs or osteochondritis dissecans, whatever you prefer.

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I want you to take a few moments and take a look at this elbow.

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Here is a frontal view.

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The lateral view doesn't contribute very much,

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but see if you can see an abnormality.

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I ask you that because many people just gloss over this abnormality without

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actually thinking twice, because it's hard to see something that's not there.

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So let's bring in, for the sake of comparison,

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the contralateral side of the same patient.

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So this is the elbow that hurts and this is the elbow that doesn't hurt.

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Can we notice something different?

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Let me point something out to you.

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On the normal side,

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let's look at the undulations of your articular surface.

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So here you have your radial head.

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You have your capitulum.

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This is your trochlea. Okay.

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And this is your ulna.

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Going along the capitellar surface,

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nice little undulations.

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Okay? Now, let's look at our abnormal side, capitulum again.

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Trochlea, radial head, and ulna.

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As I go here and go like this,

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like this,

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oh!

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Where do I go from there?

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Hmm.

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Well, let's go from the other side.

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Maybe we can connect on the other side.

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Like this.

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Oh, what's that?

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It actually goes up like this.

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So that's the abnormality.

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Right here.

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That is an osteochondral lesion.

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And it is very, very difficult to see if it's not there.

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Let me get rid of these lines for you. Right?

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So, that's what I like to call the pseudo intercondylar notch sign.

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You're never going to read that,

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but that's what I like to call it. Because this is a condyle and this is a condyle.

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There should be no notch between them. Look over here.

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Normal site condyle.

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Condyle.

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No notch.

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So, if you see a notch between the two condyles, that's abnormal.

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That is an osteochondral lesion.

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We're going to look at how this manifests on an MRI in the next vignette.