0:00

Now the second quadrant where we see findings

0:04

is the lateral compartment.

0:05

And here we get collision of the radial head

0:08

and the capella.

0:10

So we end up with osteochondral injuries

0:13

or chondral injuries more often on the humeral side,

0:16

but also involving the radial side as well.

0:20

So here is a very famous professional baseball pitcher

0:24

who has a chronic problem on the medial side with a large

0:29

and feso fight that has developed.

0:31

But I wanted to show you the typical region that we see

0:35

osteochondral injuries involving the Capella.

0:38

Typically it's the anter surface.

0:41

And this is a lesion that we often use,

0:44

often use the term osteo ance.

0:49

Now the third quadrant is the postal medial aspect

0:53

of the elbow joint.

0:55

And here we deal with impingement

0:58

and sheer uh, findings.

1:00

And so let's, uh, look at that.

1:03

This is called valgus extension overload syndrome.

1:08

That occurs when a valgus moment is coupled with near

1:12

terminal elbow extension.

1:14

And it's that particular force that produces sheer,

1:19

uh, forces as well.

1:21

That can lead to a variety of abnormalities

1:24

that often include bone proliferation, that proliferation

1:29

maybe in the form of osteophytes, especially postal medially

1:34

in the reon,

1:36

but also in the adjacent region of the reon fossa

1:41

of the humerus.

1:43

Okay? And it said the vulnerable position is 30 degrees

1:46

of elbow flexion during the deceleration phase of swelling.

1:51

Let me show you, uh, a few examples of this.

1:55

So here's one example.

1:56

Most of these cases are in baseball pitchers

1:59

and professional pitchers, showing you by diagram

2:02

where I look for the abnormality.

2:05

Here is an example of what it looks like.

2:07

You can see the contact here in that region

2:11

between a liquin on and humerus you.

2:15

I wanna also point out this.

2:17

Some people have emphasized the pointing

2:21

of the medial aspect of the eon as a sign of impingement,

2:27

but you gotta be a little careful with that particular sign

2:29

because a certain degree of pointing is seen

2:34

in normal people who do not have impingement.

2:37

So it's that finding I don't think is as reliable.

2:41

Here's another example, professional baseball pitcher.

2:44

You can see the feminization of the humerus

2:47

and the top two images,

2:48

you can see the bone proliferation nearby, okay,

2:53

near the E foa.

2:56

And here what it looks like.

2:58

That's a classic place that we will see impingement.

3:02

I wanted to point out the ulnar nerve

3:04

because some of these baseball pitchers will

3:07

develop ulnar neuritis.

3:09

It's not evident in this particular case.

3:12

Now, there are other causes of impingement that occur.

3:15

Posteriorly, oon

3:18

and thiel fights in this case associated with fragmentation,

3:22

can lead to thickening of the posterior capsule

3:25

and abnormal tissue in that region that can lead

3:29

to impingement.

3:32

Now if we look at a few other abnormalities, you will see in

3:36

baseball pitchers,

3:38

and I've seen these more often in the immature skeleton than

3:42

in ature skeleton.

3:44

There is a particular, this one happened to be in an adult,

3:46

but this is a trochlear osteochondral injury.

3:50

It's not the Osborne cutter that we saw on the,

3:53

on the other side, but this is involving

3:56

the posterior aspect of the troia.

3:59

And it's probably a sheer injury leading to cartilage loss

4:03

and leading to irregularity of the subc chondral bone plate

4:07

with nearby bone sclerosis.

4:10

So you will see this sort of abnormality.