0:01

So here we have a 15 year old girl.

0:03

She had some medial elbow pain and numbness. I have two uh,

0:09

T1 sequences here. First is the axial gonna start proximal the distal,

0:13

and if these findings don't jump out at you, that's okay.

0:15

This is a very subtle m r I case.

0:22

And as we know from tumor imaging and other, uh, imaging and radiology,

0:27

musculoskeletal cases are often aided by radiographic evaluation.

0:31

So I'm gonna show you an x-ray.

0:35

These are just two views of the elbow here.

0:38

Hopefully that abnormality is more apparent than I'm gonna go back to that M r I

0:42

image one more time. All right.

0:46

Back to our m r i.

0:49

Let me turn on a scout line here so you get an appreciation of,

0:52

of where we are in that upper extremity.

0:59

Okay? And for our next polling question.

1:04

So a supracondylar process can result in impingement if what

1:09

anomalous ligament is also present.

1:15

So what ligament can be present in association with a supracondylar process?

1:23

All right, hopefully you've had a minute to answer that.

1:26

So a little bit about supracondylar processes. Um,

1:30

this is this little o crescent from the distal humerus.

1:34

It usually rises about five to six centimeters just proximal, uh,

1:38

to the elbow joint. It's sought to be kind of a vestigial remnant. Um,

1:42

it's also called an avian spur. Uh,

1:45

and the process itself is not that uncommon,

1:48

but what is uncommon is having an associated ligament arising from the

1:53

structure, um, which is also known as struthers ligament. In fact,

1:56

it's present in less than about 1% of cases,

1:59

which is why this is not the greatest imaging case,

2:01

but the only one that we have of a struthers ligament. So, um,

2:05

and the things that can be compressed in this,

2:07

what ends up being kind of this fibro osseous tunnel from the ligament in the

2:11

osseous structure are the brachial artery or the median nerve. So, uh,

2:16

to have the ligament uncommon to compress adjacent structures even less common,

2:21

it was thought to be the cause of impingement in this particular case.

2:25

So this is one I wish we could re-image again because you can see on the, um,

2:29

coronal sequence. This is the, uh, supracondylar process here.

2:34

You can see this hypo intense cortical kind of signal here,

2:38

and we are just barely through it on our axial sequences.

2:42

So it's one I wish we would've imaged a few slices, um, more proximal,

2:46

but you can see the adjacency of that median nerve as it courses, uh,

2:50

across the elbow joint and into the proximal forearm.

2:53

And this was thought to be the cause of impingement in this patient.

2:56

She underwent surgical resection of this and had complete resolution of her

3:00

symptoms. So it's not something I necessarily would have, um,

3:04

picked up on the m r i in and of itself because it's fairly subtle.

3:07

There were no denervation changes in the muscles. But having that x-ray,

3:12

having the clinical history, um, with corresponding symptomatology really helps,

3:16

um, in these particular cases. So if you have those x-rays,

3:20

make sure you're using them for part of your evaluation.