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19b - Answer: 17-year-old male presents with right elbow pain

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

HISTORY: 

This 17-year-old male presents with right elbow pain for three days after falling onto elbow while skateboarding.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Soft tissue mass, likely lipoma.

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

FINDINGS:

Skeletal: Coronal plane fracture involves both the medial and lateral epiphyseal portions of the distal humerus with rotation (widening of the lateral interspace at the capitellum in short axis up to 6-9mm). Both the trochlea and capitellum are sheared and displaced superiorly by roughly 6mm in the sagittal plane. Tiny avulsion fracture is questioned at the tip of the coronoid process of the ulna.

Reactive 3+ joint effusion is identified without osteochondral body. Offset fracture is seen in short axis through the distal humerus.

Tendons: Biceps, triceps and brachialis intact.

Radial/Ulnar Ligaments and Tendon Origins: Radial collateral and LUCL ligaments intact. Increased signal intensity common extensor tendon origin. Ulnar collateral ligament partially torn with swelling at the proximal origin. Increased signal intensity common flexor tendon origin.

Joint Space/Cartilage: Joint effusion, 3+. No displaced osteochondral bodies are visualized.

Ulnar Nerve/Anconeus: Normal signal intensity.

No soft tissue mass.

Reactive muscle edema is demonstrated in the distal medial upper arm as well as in the proximal radial and ulnar side of the forearm.

CONCLUSION:

1. Coronal plane fracture involves both the trochlea and capitellum with offset and inner fragment widening greatest at the capitellar margin. Small chip fracture at the tip of the coronoid process is questioned.

2. Reactive elbow joint effusion without intraarticular osteochondral free fragment.

3. Associated muscular edema and strain involving radial sided extensor muscles greater than medial flexors plus myoedema distal medial upper arm brachialis fibers.

4. Swelling at the origin of the UCL with associated partial tear.

LESSON 2, TOPIC 57

Case Challenge: Elbow MRI Cases

Case Challenge

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Content reviewed: October 28, 2021

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