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18b - Answer: 43-year-old female presents with pain of left elbow

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 43-year-old female presents with pain and decreased range of motion of left elbow after a fall and hyperextension of elbow four days prior.

(QUIZ ANSWER) ALSO A FINDING IN THIS CASE: 

All of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Large depressed capitellar fracture with moderate-sized elbow hemarthrosis. Fracture is located along the back of the capitellum, a sign of an elbow dislocation and Osborne-Cotterill fracture.

In addition, small peel-like tear of the medial collateral ligament distally at the insertion on the tubercle.

Furthermore, partial thickness tear of the proper collateral ligament proximally. Posteriorly, lateral ulnar collateral ligament is torn from its origin, full-thickness.

Lower grade radial collateral ligament proper tear.

Distal separation of the ulnar collateral ligament from the sublime tubercle.

Capsule remains intact.

Brachialis is intact. 

Coronoid is intact. 

Ulnar nerve is unaffected, however mild compression due to surrounding edema.

CONCLUSION:

Osborne-Cotterill fracture of the capitellum with full-thickness lateral ulnar collateral ligament tear at the origin, medial collateral ligament insertion peel-like tear distally, partial thickness tear of the proper collateral ligament, and low grade radial collateral ligament proper tear. Associated moderate-sized hemarthrosis. Findings consistent with posterolateral elbow dislocation. Intact capsule, brachialis, and coronoid.

LESSON 2, TOPIC 54

Case Challenge: Elbow MRI Cases

Case Challenge

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Content reviewed: October 28, 2021

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