MRI of the elbow (an approach)

MRI of the elbow is a fairly frequent examination in musculosceletalmusculoskeletal radiology practice and not quite as common in a general radiological practice. This approach is a an example of how to create a radiological report of an elbow MRI with coverage of the most common anatomical sites of possible pathology, within the shoulder without claim for completeness.

Systematic review

A systematic review in the MRI of the elbow is essential since elbow anatomy, pathologies and injury patterns and are rather complex  andand only rarely lead to an abnormality of a single structure but rather show diverse findings which might need to be addressed in further patient management.

Bones

The bony structures of the elbow, the pictured distal humerus with the trochlea, capitellum and the two epicondyles, the radial head and the proximal ulna with the olecranon are assessed:

• fractures
• bone tumours

Joint space and capsule

• assessment of the following structures:
  • joint space, joint effusion if present and possible intra-articular fragments or loose bodies
• synovia
  • synovial thickening and hyperenhancement and other abnormalities
  • humeroradial plica syndrome

Ulnohumeral articulation

Assessment of the following structures:

• ulnohumeral joint cartilage and subchondral bony structures
  • chondral and osteochondral injury, subchondral fractures and subchondral cysts and or  osteoarthritic changes of the trochlea and olecranon
• posterior compartment
  • subchondral sclerosis, osteophytes in valgus extension overload syndrome and posteromedial impingement
• coronoid process
  • coronoid process fracture
• medial (ulnar) collateral ligament complex (anterior and posterior bundle)  
  • elbow dislocation, valgus instability, advanced  posterolateral rotatory instability
• medial epicondyle
  • golfer's elbow, medial epicondyle apophysitis
• common flexor and pronator origin
  • golfer's elbow, tendon or muscle injury/tears

Triceps tendon, ulnar nerve and posterior soft tissues

Assessment of the following structures:

• distal triceps tendon
  • variant anatomy
  • triceps tendinopathy, triceps bony avulsion, tendon rupture
• olecranon bursa
  • olecranon bursitis
• cubital tunnel and ulnar nerve
  • variant anatomy (anconeus epitrochlearis muscle, thickened or absent retinaculum)
  • ulnar nerve dislocation

Radiocapitellar articulation and proximal radiolulnarradio-ulnar joint

Assessment of the following structures:

• radiocapitellar cartilage and subchondral bony structures
  • chondral and osteochondral injury, subchondral fractures and subchondral cysts, osteoarthritic changes of the capitellum and radial head
  • lateral radiocapitellar compression, Osborne-Cotterill lesion
• lateral (radial) collateral ligament complex with the lateral ulnar collateral ligament (LUCL) and radial collateral ligament and theannular ligament
  • posterolateral rotatory instability
• medial epicondyle
  • tennis elbow
• common extensor origin
  • tennis elbow, tendon or muscle injury/tears

Pitfalls

• pseudodefectpseudo defect of the capitellum

Distal biceps tendon

Assessment of the distal biceps tendon insertion:

• biceps tendon rupture, partial tears
• posteroperativepostoperative changes, re-tear,  heterotopic ossification

Volar soft tissues and median and radial nerves

Assessment of the following structures:

• brachialis, brachioradialis, supinator muscles, pronator teres muscle
  • muscle oedema, muscle injury, brachialis tendon avulsion
• median nerve
  • pronator syndrome
  • anterior interosseous nerve compression syndrome
• radial nerve (between brachialis and brachioradialis muscle Arcade de Frohse)​
  • posterior interosseous nerve compression syndrome

Common pathology

• tennis elbow
• golfer's elbow
• elbow instability
• posterolateral rotatory instability
• valgus extension overload syndrome   
• biceps brachii tendon tear
• snapping triceps syndrome
• ulnar, median or radial nerve compression syndromes
• olecranon bursitis
• lipoma