0:00

Continuing from the last vignette, where I

0:02

showed you the radiographs, here they are,

0:05

of the abnormal versus the normal elbow.

0:09

The abnormal side demonstrating this

0:11

divot, if you will, the pseudo-endocondylar

0:14

notch sign, is a representation of

0:17

a trochlear osteochondral lesion.

0:20

This is the capitellum. This entire thing is

0:22

a trochlea, so there's a notch right here,

0:24

that's the trochlear osteochondral lesion.

0:26

It's not a capitellar osteochondral

0:28

lesion, which is more common, but

0:30

a trochlear osteochondral lesion.

0:33

So let's see what that looks like on the MRI.

0:35

Coronal T1-weighted sequence and a coronal

0:40

fat-suppressed fluid-sensitive sequence.

0:42

On the T1-weighted sequence, this is

0:44

kind of like our plain radiographs.

0:46

This is equivalent to a plain

0:47

radiograph in an MRI, if you had one.

0:49

We notice that there, again, is the

0:52

capitellum and there's that divot.

0:54

That divot should not be there.

0:56

So that is our osteochondral lesion.

0:58

If you look on the fluid-sensitive sequence,

1:00

you notice that that osteochondral

1:02

lesion does have edema around it, right?

1:04

So it is an active lesion.

1:06

It probably is causing

1:07

some degree of inflammation.

1:09

So this is the patient in October 2018,

1:14

and we performed this examination.

1:16

We called the osteochondral lesion,

1:18

but there really wasn't anything else.

1:21

At our institution, we often will

1:24

perform arthrograms to evaluate the

1:27

stability of an osteochondral lesion

1:29

or to look for other concurrent problems.

1:31

Or if we think we're missing a loose

1:34

body, we will do an arthrogram.

1:36

So this patient was treated conservatively,

1:39

resting, but continued to have pain.

1:42

So we decided to do an arthrogram.

1:45

So I'll show you briefly how we do arthrograms.

1:47

We do it all under ultrasound guidance

1:50

and we use a posterior approach.

1:52

And in the next vignette, I'll

1:54

show you exactly how we do that.