0:01

This one's a pretty straightforward case,

0:05

as you've heard the, um, flexor pronator mass.

0:09

The pronator has more or less of a separate origin,

0:14

and I, I'm not showing an origin problem.

0:17

Um, but we are talking about tendons.

0:21

Um, but the patient does have an abnormality

0:24

of the medial epicondyle.

0:26

So-called golfer's elbow.

0:29

I wouldn't know because I don't play golf.

0:32

Um, but I, I showed this for another reason,

0:35

and let's focus for a moment on the common extensor, uh,

0:39

which is right here.

0:41

And you, you can separate the

0:44

lateral collateral ligament from the common extensor.

0:47

And as mentioned with severe longstanding common extensor

0:51

disease, I do get asked to assess the status of this.

0:54

And sometimes I'll see lateralization, uh, of the radius.

0:59

There's the rest of the lateral ulnar collateral, uh,

1:02

ligament, uh, focusing on the medial side

1:05

where the patient's symptoms are.

1:07

There is some signal right at the origin,

1:10

and it's pretty high up, uh, uh, in the region

1:13

of the pronator Terry origin.

1:15

But as you come down, the flexor pronator mass, uh,

1:19

demonstrates interstitial signal.

1:22

And I wanted to take a moment, uh, to talk to you about

1:26

the evaluation of myotendinous unit injuries,

1:30

which really comes from, uh, the financial risk

1:35

that our colleagues in Europe take with some

1:38

of these soccer players, trading them from one team

1:41

to another for 10, 20, $50 million.

1:44

So they're very focused on, uh, myotendinous unit injuries,

1:48

and they have come up with various grading systems, one

1:51

by the Germans, one by the Italians, and one by the British.

1:56

Now, why else do I mention this?

1:59

Because orthopedic surgeons in the United States

2:03

who take care of high performance athletes, have adopted

2:07

many of these criteria.

2:08

And what do these criteria include?

2:11

They include percent cross-sectional area.

2:16

So they, they want to know that,

2:17

and I'll get asked this in every, every single case,

2:20

they'll wanna know if there is a defect.

2:24

So when I say percent cross-sectional

2:26

area, I don't mean the defect.

2:27

I mean the area that is emus or swollen,

2:32

and they wanna know the defect

2:34

and they wanna know the dimensions of that defect.

2:37

They want to know length.

2:39

This is particularly apropos when you're dealing

2:41

with a hamstring,

2:43

but it's apropos when you're dealing with,

2:45

with any, any muscle group.

2:48

They want to know if there's blood.

2:50

They wanna know if there's a, a drainable fluid collection,

2:55

you know, and if there is, they'll drain it.

2:56

And sometimes they'll put, uh, PRP,

3:00

uh, in that structure.

3:02

Then they wanna know if the myo tendonous junction is

3:06

involved, or is it purely muscular

3:09

or is it purely tendinous?

3:11

And those are the major tenets.

3:13

Now our colleagues in Europe will give this a score.

3:16

I do not score it.

3:18

Our United States colleagues do not ask for a score.

3:22

And, um, in this case you can see involvement, uh,

3:25

that is mostly interstitial.

3:27

There are no defects.

3:29

We could give a length, and we could also give a

3:32

cross-sectional area if we had some time.

3:34

Uh, but this would be considered a low grade injury.

3:38

So I thought I'd share that tidbit of history

3:41

and the orthopedic surgeons

3:43

and radiologists approach to myotendinous unit injuries.

3:47

Don, any comments on this?

3:48

The, the one, I mean, I, I think we

3:51

also consider pretty much all of those factors.

3:54

The one that seems to be of greatest interest is the length.

3:58

But do, do you find that that

4:00

to be one more important than the others?

4:02

But it seems to be, that's the one that I've been asked

4:06

by phone calls, uh, on a few of the cases, how long it is.

4:10

And, and I don't know if, if in those systems in Europe

4:15

that is given more weight or not.

4:17

I would say there are three big ones.

4:19

The length is certainly one of them.

4:21

Another one is there a defect

4:22

where you don't see fibers running through it.

4:25

And then the third one, um, which is very relevant today,

4:31

is, is the myotendinous junction affected, uh,

4:35

or is it simply pure tendus or pure muscular?

4:38

It seems like the ones right at the myotendinous junction

4:41

tend to take longer, uh, to, to heal,

4:44

unless it's a tendon rupture,

4:46

which is a whole nother ballgame.

4:47

And they have, uh, for all those a return

4:50

to activity table, probably that tells them, depending on

4:54

what you give them as those measurements

4:57

or descriptors, that will tell them

5:00

when the person can return to

5:02

That, they want to know. And even

5:03

a low grade injury that involves a myo tenus unit,

5:06

if it is a weight bearing structure,

5:09

it usually takes about six weeks.

5:10

Yeah.