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23b - Answer: 10-year-old male presents with left elbow pain

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

HISTORY: 

This 10-year-old male presents with left elbow pain since falling from a slide.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Intermediate-grade strain of the pronator teres muscle.

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

FINDINGS:

The bones are in anatomic alignment. Abnormal linear low T1 signal is identified within the radial head associated with osteoedema consistent with a microtrabecular fracture. Small joint effusion noted. No loose bodies. 

The biceps, brachialis and triceps tendons are intact. 

Moderate edema of the flexor digitorum superficialis muscle noted with attenuation of the fibers consistent with grade 2 strain. Moderate perifascial edema noted about the medial muscles. Edema of the supinator muscle also noted consistent with low-grade strain.

The ulnar collateral ligament anterior band is ruptured. The radial collateral ligament is intact. Intact LCL. The common flexor tendon is contused. The common extensor tendon is intact. 

Moderate subcutaneous edema about the elbow. 

CONCLUSION

DISLOCATED ELBOW WITH RADIAL FRACTURE AND UCL RUPTURE, VALGUS MECHANISM.

1. Little displaced fracture of the radial head. UCL anterior band ruptured.

2. Intermediate-grade strain of the flexor digitorum superficialis muscle associated with contusion of the common flexor tendon. 

3. Low-grade strain of the supinator muscle. 

4. Intact LCL despite signs of dislocation such as coronoid chip fracture.

5. Small joint effusion and generalized subcutaneous edema about the elbow.

LESSON 2, TOPIC 69

Case Challenge: Elbow MRI Cases

Case Challenge

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Content reviewed: October 28, 2021

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