0:01

Thank you, Don.

0:02

You have the misfortune of sitting next to an X boxer,

0:05

and, uh, did you develop that?

0:07

I did. And I can tell you that the most annoying thing

0:10

as a posterior elbow ache

0:13

and typically pictures with early valgus extension overload,

0:16

that is the first thing they complain about,

0:18

is discomfort in the back of their elbow

0:21

before anything else occurs.

0:24

I'm going to start out now with a, um, uh,

0:27

with an interesting case.

0:28

This is a professional athlete.

0:30

He's a, he is an American football quarterback.

0:33

And as most of you know,

0:34

and some of you that are overseas may not know

0:38

that a professional quarterback

0:40

or any quarterback does not really do a lot of rotation.

0:43

They do, don't do a lot of pronation

0:46

or supination like our friends in American baseball.

0:50

Uh, and that affects the, the types

0:52

of problems that you're going to see.

0:54

And, and the fact that they don't rotate enhances the fact

0:58

that they may spontaneously resolve certain

1:01

types of injuries.

1:03

So this gentleman, um, a very, a very valuable, uh, player,

1:08

um, in the National Football League, um, was throwing a ball

1:13

and decelerating his arm on the helmet of another team,

1:17

the New York Giants by the way.

1:19

And after that, he was unable to throw the ball down field,

1:24

which is about 60 yards.

1:26

He could only throw the ball 30 yards

1:28

and with about three quarters velocity.

1:30

So he was still able to throw the ball, which meant

1:32

that his injury was unlikely to be catastrophic.

1:36

We've got a 1.7 millimeter coronal gradient echo image

1:40

that shows some disorganization

1:42

of the internal architecture of the ligament.

1:45

And you might say to yourself, well, well, maybe

1:47

that's just the gradient echo and,

1:49

and perhaps some magic angle effect,

1:51

but superficial to that layer number one

1:54

of the UCL is the flexor digitorum

1:58

superficialis pon neurosis, and,

2:01

and that is subtly swollen, not so subtle

2:05

on the proton density, fat suppression,

2:07

and the disorganization is a little more apparent.

2:11

The T one weighted image, i, i is really not that helpful,

2:15

although it does exclude the presence, uh, of,

2:18

of a bone abnormality.

2:20

So a firestorm ensued, uh,

2:22

after this case, uh, as to whether the patient would be able

2:26

to play, when they would be able to play and what to do.

2:30

Um, and he, he got a,

2:32

a consulting opinion from New York City, um,

2:36

and they said that he absolutely needed a,

2:40

a repair of the ulnar collateral ligament,

2:43

which would've put him out of football for 16 to 18 months.