0:00

Let's see, 64 injured while lifting a heavy object

0:05

and felt a a pop.

0:08

Okay, so we're talking about tendons.

0:11

So hopefully there are tendon abnormalities in this case.

0:16

And there are, um, there are some small

0:22

fleck of osseous material here.

0:25

And let's start out on the medial side

0:27

where there is a little bit of signal at the origin of the,

0:30

uh, pronator tes or flexor pronator masses.

0:34

But it's far more obvious on the lateral side.

0:38

And in my experience, as you described, uh,

0:42

over 90% of these occur in the ECRB,

0:46

the extensor carp radiologist brevis.

0:49

So he does have lateral epicondylitis.

0:52

And when I have a confluent defect, in other words,

0:56

I see white signal like fluid, I'm going

0:59

to give them the delamination tear description.

1:03

And that may be a good thing, Don,

1:05

because one of the treatments for this is, is to, uh,

1:08

cut it away, uh, to separate it.

1:11

Uh, so perhaps the patient is performing the surgery

1:13

themselves, although admittedly, the overwhelming majority

1:18

of these can be cured by a combination of PRP

1:22

and then mashing that area to enhance the blood supply.

1:26

Uh, because one of the problems

1:28

with this is it becomes fibrosed

1:30

and blood can't get into heal it.

1:33

So we at least have one, one tendon abnormality.

1:37

Let's take a look at, uh, the biceps

1:43

and, um, we have a,

1:44

we have another tendon abnormality while we'll at it.

1:47

Here's just a quick look at the triceps.

1:49

I think that's okay. And here's our biceps.

1:54

And our biceps demonstrates two owls eyes,

1:58

which is not usually the case.

2:01

Uh, it's usually one structure,

2:03

and the one that is more medial is going

2:07

to be the short head.

2:09

And, uh, the short head's gonna insert, as you mentioned,

2:11

a little more distally.

2:13

There's the long head,

2:15

and typically they'll merge somewhere around three

2:18

to five centimeters proximal to

2:21

where they insert on the radial tuberosity.

2:23

But sometimes you have a bifid insertion.

2:26

Now as you follow these down, you, you,

2:28

you lose them both virtually,

2:31

although this one, you know, while it's awfully sick

2:35

and intermediate and signal intensity persists

2:38

and goes distally.

2:39

So that is the short head.

2:41

So the short head does make it,

2:43

even though it is a high grade tear

2:45

and the long head does not make it.

2:47

And then as we go up more proximally, we run into a,

2:51

a diseased, swollen lacer fibrosis.

2:55

And the clinicians that I work with

2:58

a wanna know if the erti is damaged,

3:00

and B, do we have a tear that is pre erti

3:04

or post erti in character?

3:07

I think those are the major findings in this case.

3:10

So we've got, we've got a bevy of, of,

3:13

of tendon abnormalities that, tableau of them, in fact.

3:16

Um, any comments on this one?

3:18

Yeah, well, I mean, so as, as you described,

3:21

and I always find these difficult is what I was, was saying,

3:24

that, uh, you have to go back and forth and look at them.

3:28

But yeah, antral, medial

3:31

and anterior is the typical position

3:33

of the short head compared to longhead.

3:35

I only show, uh, I showed three cases

3:39

of these high grade tears or full thickness of one

3:42

and out of the other, uh, except for one case in my,

3:46

this would be unusual only in,

3:49

it's usually the short head that's torn.

3:51

Sure. And the long head that is not torn it.

3:55

And I've probably seen 12 of those,

3:57

and one in which the opposite was, was intact.

4:02

So the long head was torn and the short head was intact.

4:06

But, uh, to me, when I look at 'em, I,

4:10

I can't go as fast as you do.

4:11

I usually have to trace these very, very carefully in

4:15

multiple imaging planes before I'm actually, and

4:18

I had a feeling you would bring that up,

4:20

and so I brought up the sagittal.

4:22

Yeah. And you can see the anterior structure is the one

4:24

that goes a little more distal.

4:26

And the posterior structure, which is the long head,

4:29

is the one that stays a little more proximal,

4:31

Very unusual. It

4:33

Is an unusual tear.