Magnetic Resonance Imaging of Elbow Instability

ABSTRACT

Traumatic injury of the elbow, both in the acute setting as well as in the setting of chronic repetitive microtrauma, is quite common. Specifically, the frequency of elbow dislocation is second only to that of the shoulder. Unlike the shoulder, however, the elbow is an inherently stable articulation, considered one of the most congruous joints in the body. This manuscript discussed imaging techniques for elbow evaluation in the setting of instability and reviews the osseous anatomy, as well as the anatomy of the soft tissue stabilizers of the elbow. Anatomic variants, potential pitfalls in imaging diagnosis, and the imaging findings associated with various types of elbow instability are considered.

KEYWORDS

MR Imaging - elbow - instability

REFERENCES

• 1 O'Driscoll S W. Classification and evaluation of recurrent instability of the elbow.  Clin Orthop. 2000;  370 34-43
• 2 Sugimoto H, Hyodoh K, Shinozaki T. Throwing injury of the elbow: assessment with gradient three-dimensional, Fourier transform gradient-echo and short tau inversion recovery images.  J Magn Reson Imaging. 1998;  8 487-492
• 3 Cotten A, Jacobson J, Brossmann J et al.. Collateral ligaments of the elbow: conventional MR imaging and MR arthrography with coronal oblique plane and elbow flexion.  Radiology. 1997;  204 806-812
• 4 Kim Y S, Yeh L R, Trudell D, Resnick D. MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm.  Skeletal Radiol. 1998;  27 419-426
• 5 Patel V V, Heidenreich Jr F P, Bindra R R, Yamaguchi K, Gelberman R H. Morphologic changes in the ulnar nerve at the elbow with flexion and extension: a magnetic resonance imaging study with 3-dimensional reconstruction.  J Shoulder Elbow Surg. 1998;  7 368-374
• 6 Gelberman R H, Yamaguchi K, Hollstien S B et al.. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavers.  J Bone Joint Surg Am. 1998;  80 492-501
• 7 Giuffre B M, Moss M J. Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view.  AJR Am J Roentgenol. 2004;  182 944-946
• 8 Nakanishi K, Masatomi T, Ochi T et al.. MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.  Skeletal Radiol. 1996;  25 629-634
• 9 Steinbach L S, Palmer W E, Schweitzer M E. Special focus session. MR arthrography.  Radiographics. 2002;  22 1223-1246
• 10 Rosenberg Z S, Beltran J, Cheung Y Y. Pseudodefect of the capitellum: potential MR imaging pitfall.  Radiology. 1994;  191 821-823
• 11 Rosenberg Z S, Beltran J, Cheung Y, Broker M. MR imaging of the elbow: normal variant and potential diagnostic pitfalls of the trochlear groove and cubital tunnel.  AJR Am J Roentgenol. 1995;  164 415-418
• 12 Rosenberg Z S, Bencardino J, Beltran J. MR imaging of normal variants and interpretation pitfalls of the elbow.  Magn Reson Imaging Clin N Am. 1997;  5 481-499
• 13 Clarke R P. Symptomatic, lateral synovial fringe (plica) of the elbow joint.  Arthroscopy. 1988;  4 112-116
• 14 Cohen M S, Bruno R J. The collateral ligaments of the elbow: anatomy and clinical correlation.  Clin Orthop. 2001;  383 123-130
• 15 Chung C B, Kim H J. Sports injuries of the elbow.  Magn Reson Imaging Clin N Am. 2003;  11 239-253
• 16 Munshi M, Pretterklieber M L, Chung C B et al.. Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analysis.  Radiology. 2004;  231 797-803
• 17 Timmerman L A, Andrews J R. Histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow.  Am J Sports Med. 1994;  22 667-673
• 18 Fowler K A, Chung C B. Normal MR imaging anatomy of the elbow.  Magn Reson Imaging Clin N Am. 2004;  12 191-206
• 19 Sofka C M, Potter H G. Imaging of elbow injuries in the child and adult athlete.  Radiol Clin North Am. 2002;  40 251-265
• 20 Yoshioka H, Ueno T, Tanaka T et al.. High-resolution MR imaging of the elbow using a microscopy surface coil and a clinical 1.5 T MR machine: preliminary results.  Skeletal Radiol. 2004;  33 265-271
• 21 Schwartz M L, al-Zahrani S, Morwessel R M, Andrews J R. Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography.  Radiology. 1995;  197 297-299
• 22 Mirowitz S A, London S L. Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation.  Radiology. 1992;  185 573-576
• 23 Carrino J A, Morrison W B, Zou K H, Steffen R T, Snearly W N, Murray P M. Noncontrast MR imaging and MR arthrography of the ulnar collateral ligament of the elbow: prospective evaluation of two-dimensional pulse sequences for detection of complete tears.  Skeletal Radiol. 2001;  30 625-632
• 24 Phillips C S, Segalman K A. Diagnosis and treatment of post-traumatic medial and lateral elbow ligament incompetence.  Hand Clin. 2002;  18 149-159
• 25 Mulligan S A, Schwartz M L, Broussard M F, Andrews J R. Heterotopic calcification and tears of the ulnar collateral ligament: radiographic and MR imaging findings.  AJR Am J Roentgenol. 2000;  175 1099-1102
• 26 Timmerman L A, Andrews J R. Undersurface tear of the ulnar collateral ligament in baseball players. A newly recognized lesion.  Am J Sports Med. 1994;  22 33-36
• 27 Timmerman L A, Schwartz M L, Andrews J R. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation.  Am J Sports Med. 1994;  22 26-31
• 28 Dunning C E, Zarzour Z D, Patterson S D, Johnson J A, King G J. Ligamentous stabilizers against posterolateral rotatory instability of the elbow.  J Bone Joint Surg Am. 2001;  83 1823-1828
• 29 Potter H G, Weiland A J, Schatz J A, Paletta G A, Hotchkiss R N. Posterolateral rotatory instability of the elbow: usefulness of MR imaging in diagnosis.  Radiology. 1997;  204 185-189