0:01

So this next patient, I believe, is a 43-year-old man.

0:07

He is, had pain with multiple injections.

0:10

I I do not have a specific history of injury,

0:14

but he must have had one.

0:16

And I'm gonna put up all three coronals first

0:19

as I am likely to do.

0:22

Let's see. Sorry about that.

0:24

I'm putting up my coronal, I've got two, sorry, my sagittal,

0:28

I've got two coronals, a t, one on the left

0:32

and a heavily fat suppressed image in the middle.

0:36

I've got my sagittal fat suppressed image on the far right

0:41

and the obvious finding, well, there are a couple

0:44

of interesting findings.

0:45

First, he's got this, uh, very prominent, uh, in imagination

0:50

or click alike band there.

0:53

And he is also got this large gaping area of hyperintensity,

0:59

which, which is consistent with detachment

1:01

of the common extensor mechanism.

1:03

But let's take a look at his, his collateral ligaments,

1:07

his radial collateral ligament, which I refer to

1:10

as the proper collateral ligament,

1:12

slightly different terminology, um, is, is, is ruptured.

1:17

And you see that the radius is, is starting

1:20

to lateralize just, just a little bit.

1:23

You know, you lose this conformity here

1:26

and the patient is developing

1:27

because of the wiggling of the radius, a little bit

1:30

of chondro lac.

1:32

So we refer to this as a, as a very early manifestation

1:35

of a, of a sloppy hinge.

1:37

On the other hand, the lateral ulnar collateral ligament,

1:42

which we see coming towards the Christus sup, Naus ridge

1:46

of the ulnar course is behind the radius.

1:49

And we can see it's a little bit swollen at its origin.

1:52

And, and that origin is often confused

1:54

with the common extensor tendon by, by young radiologists.

1:58

The common extensor is over here.

2:00

And then you can cross reference it over here

2:03

and, you know, you see it right there, um, maybe not as well

2:07

as you do in the coronal projection.

2:09

Then you go over to the medial side

2:11

because we've been talking about, uh, dislocations.

2:14

This patient doesn't, hasn't had one,

2:17

but there is your anterior bundle

2:19

of your medial collateral ligament.

2:21

And look at the, look at the snuggle, the snuggle of the,

2:26

uh, medial collateral ligament

2:28

with the sublime tubercle of the ulnar.

2:29

There's absolutely no space there whatsoever.

2:33

Yet this patient is 43 years of age.

2:35

There's the normal fan shape

2:37

of the proximal ulnar collateral ligament.

2:40

And let's just have a brief view of the remainder

2:44

of the medial collateral, uh, ligament.

2:47

So in the axial projection, we discussed earlier

2:50

that there is a posterior component

2:53

forming the floor of the cubital tunnel.

2:54

There it is. There's your ulnar nerve.

2:57

And then superficially you've got this, uh, very thin, uh,

3:01

posterior component of the UCL,

3:04

which sometimes is a little hard

3:06

to separate out from a thin layer

3:08

of fascia called osborne's fascia.

3:11

And as, as Dr.

3:12

Resnick mentioned, you do get a lot

3:14

of these small spurs in the back.

3:17

So you have to be a bit circumspect about what

3:19

to call a pathologic spur, a symptomatic spur or otherwise.

3:24

Shall we move on to the next case?

3:26

Unless you have any comments on this

3:27

One? Well, the only comment

3:28

I would have is that spur.

3:31

I don't think there've been any good studies as to the size

3:35

of that particular spur.

3:36

I know I heard about it initially from Lynn Steinbeck years

3:39

ago, and I think someone should do a project on that

3:43

because I know a lot of people see that

3:45

and start talking about pathologic spurs,

3:48

which can occur there.

3:49

But I don't know what the measurement of the normal

3:52

outgrowth is in that, uh, in that region.

3:56

And, uh, so that's something

3:58

that anyone out there is interested in doing any research

4:00

that might be a good project.

4:02

I mean, one thing my orthopedic colleagues have told me is

4:05

there's some variability as to which

4:07

of the two ligaments provides the major stability from

4:10

person to person, whether it's the lal,

4:12

the lateral NOCO collateral ligament or the RCL.

4:16

I mean, most people, you

4:17

and I probably included believe it's the Lal

4:20

rather than the RCL.

4:21

A lot of the orthopedic community has the,

4:24

has the other, uh, position.

4:26

But I'd, I'd be a little concerned about

4:28

postal lateral rotatory instability in a case like this

4:32

that's longstanding.

4:34

I think a lot of orthopedic surgeons over

4:37

an anonymous don't give as much credit to ligaments

4:40

that don't connect bone to bone.

4:42

Agree. And so that's why I think a lot

4:44

of people didn't think initially

4:46

that the radio collateral ligament was a critical, uh,

4:50

you know, ligament, but well,

4:51

When I first started describing it, I get calls, what is

4:54

that from the orthopedic community.

4:56

So you're absolutely right.