MRI of the Elbow: Techniques and Spectrum of Disease

Editorial Review

MRI of the Elbow: Techniques and

Spectrum of Disease

Ashvin K. Dewan, MD, A. Bobby Chhabra, MD, A. Jay Khanna, MD, MBA, Mark W. Anderson, MD, Lance M. Brunton, MD

J Bone Joint Surg Am. 2013;95:e99(1-13)

JACO Editorial Reviewer: Cliff Tao DC DACBR

Published: June 2017

Journal of the Academy of Chiropractic Orthopedists

2017, Volume 14, Issue 2

The original article copyright belongs to the original publisher. This review is available from: www.dcorthoacademy.com © 2017 Tao and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author’s Abstract:

Background: Magnetic resonance imaging (MRI) of the elbow allows for high-resolution evaluation of osseous and soft tissue structures, including ligaments, tendons, nerves, and muscles. Multiple imaging techniques and pulse sequences exist. The purpose of this article is to update orthopaedic surgeons on current MRI techniques and illustrate the spectrum of elbow pathology detectable by MRI.

Methods: We searched MEDLINE with use of the keywords ‘‘MRI’’ and ‘‘elbow’’ for studies less than five years old evaluating MRI techniques. These papers, our experience, and textbooks reviewing elbow MRI provided the information for this article.

Results: We discuss the essentials and applications of the following techniques: (1) conventional, non-gadolinium enhanced MRI; (2) gadolinium-enhanced MRI; and (3) magnetic resonance arthrography. The classic MRI appearances of occult fractures, loose bodies, ulnar collateral ligament injuries, lateral collateral ligament complex injuries, biceps tendon injuries, triceps tendon injuries, lateral epicondylitis, medial epicondylitis, septic arthritis, osteomyelitis, osteochondritis dissecans, compression neuropathies, synovial disorders, and various soft-tissue masses are reviewed.

Conclusions: MRI is a valuable, noninvasive method of elbow evaluation. This article updates orthopaedic surgeons on the various available MRI techniques and facilitates recognition of the MRI appearances of the most commonly seen pathologic elbow conditions.

JACO Editorial Summary:

  • This is an exhibit selection, which is way of bringing select recent exhibits from a meeting which are felt to have potential reader interest, to publication. There is very little or no peer review process.
  • The authors of this exhibit/article are from the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland; the Departments of Orthopaedic Surgery and Radiology, University of Virginia, Charlottesville, Virginia; and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
  • The purpose of this article is to update the reader on general MRI sequences of the elbow and to show examples of common elbow pathology on MRI. Of note the article emphasizes the use of a fluid-sensitive sequence, such as STIR or fat-suppressed T2-weighted imaging.
  • The authors state a Medline search was used to procure studies not more than 5 years old but do not describe the inclusion critieria. Of interest is that over half of the articles referenced are at least 10 years old. The authors also used their experience and textbooks to provide information for this article.
  • A concise review of types of elbow MRI is presented with common indications. Intravenous contrast-enhanced elbow MRI is commonly preferred for the evaluation of soft tissue masses and synovial disorders including inflammatory arthritides. Bone perfusion and viability are also shown with IV contrast enhanced MRI. MR arthrography is indicated for intra-articular or periarticular pathology such as collateral ligament and capsular tears, osteochondral lesions, and articular bodies.
  • A brief synopsis of MR imaging features of various disorders related to trauma (occult fracture, articular [loose] bodies, collateral ligament injury, biceps/triceps tendon injury), degeneration (medial and lateral epicondylosis), infection (septic arthritis, osteomyelitis), and other conditions such as osteochondral defects, compression neuropathies, synovial disorders, and soft tissue masses is presented.

Summary:

This article is a good review to help the chiropractor and the chiropractic orthopedist by suggesting when MRI, when intravenous and intra-articular contrast, and even which specific sequences are indicated in the differential diagnosis of elbow pain. MRI is a valuable, non-invasive tool in the evaluation of the elbow and this article shows examples of common conditions that may be seen in the chiropractic office.

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