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6 Cards in this Set

  • Front
  • Back
1. Why is the term "epicondylitis" a misnomer?
2. What are the imaging findings of tendinosis?
3. What are the radiographic findings in chronic cases of epicondylitis?
1. Epicondylitis is a misnomer because the majority of patients suffer from tendinosis of the common forearm flexor and extensor tendons.
2.
- Thickening of the tendinous insertions.
- Altered signal intensity in the tendon in both T1W and T2W images.
- Edema in the adjacent bone marrow.
3. Chronic changes may be detected radiographically and consist of dystrophic calcification at the enthesis of the tendon and cortical irregularity at the humeral epicondyles.
1. What is the site of origin and attachment of the biceps muscle?
2. What is the mechanism of biceps tendon rupture?
3. Where do most biceps tendon failures occur, at the insertion or at the musculotendinous junction?
4. What are the MRI findings?
1. The biceps brachii muscle originates from two locations on the scapula, the supraglenoid tubercle and the tip of the coracoid process, and inserts on the bicipital tuberosity of the proximal radius.
2. Forced hyperextension of a flexed elbow or forced flexion against resistance.
3. At the radial insertion.
4. Look for a gap between the avulsed tendon and bicipital tuberosity. On T2W images, edema in and around the tendon may be noted, and the gap may be filled with fluid.
1. What is the most common elbow dislocation?
2. What fractures are associated with elbow dislocations?
3. What is a complication of elbow reduction?
1. Posterior elbow dislocations are more common and result from FOOSH.
2. Fx of the coronoid process, radial head fx, supracondylar fx.
3. Avulsion of the medial epicondylar ossification center which may become entrapped in the joint as the ulnar collateral ligament and the common flexor tendons insert upon the undersurface of the medial epicondyle.
Chronic recurrent multifocal osteomyelitis (CRMO)
SAPHO
- Autoinflammatory disorder of bone with fever, multifocal painful nonpyogenic bone lesions, relapsing and remitting course in children and adolescents.
- Commonly involves the distal femur, proximal and distal tibia, distal fibula, clavicles. Upper extremity involvement is rare, except the clavicle. Clavicular involvement fairly unique for CRMO, when present.
- Adult disease is SAPHO syndrome (synovitis, acne, palmar pustulosis, hyperostosis, osteitis).
1. What is the mechanism of Little league elbow?
2. What is the stabilizer in valgus strain in adults? children?
3. How does injury to the medial elbow present in adults? children?
4. How does medial epicondyle avulsion present?
5. What is the appearance of a chronic repetitive injury?
6. What is a complication of medial side injuries?
1. Repetitive valgus stress on a skeletally immature elbow leads to chronic tesnile stress on the medial elbow (lead to apophysitis) and compressive forces on the lateral elbow (lead to OCD of capitellum).
2. In adults, the majory of articular stability comes from ligamentous support. In children, the ligament are lax; thus, the majority of support comes from tendons. At the elbow, the main stabilizer against valgus strain is the common flexor-pronator tendon.
3. In adults, severe valgus stress leads to sprain or rupture of the medial collateral ligament. In children, the force is transferred to the tendon which is stronger than the unfused medial epicondyle leading to either apophysitis or avulsion.
4. Acute avulsion presents as visible separation of the medial epicondyle. The medial epicondyle may become entrapped within the joint mimiking a trochlear ossification center. NOTE: trochlea ossifies at 9 year in girls and 10 years in boys.
5. Chronic repetitive injury demonstrates fragmentation.
6. Ulnar neuropathy
1. What is Panner's disease? What is the appearance of Panner's disease?
2. What is the age range for Panner's disease? OCD?
3. What is the long term sequelae of Panner's disease and OCD?
1. Avascular necrosis of the capitellum.
- Fragmentation and increased density of the capitellum
- Resorption of the radial head
- Increased size of the radiohumeral space
- radiolucent band may appear at the capitellum similar to crescent seen in hip osteonecrosis
- irregular contour deformity

2. Panner's disease is seen in boys 5-10 years old when the capitellum is incompletely ossified. OCD occurs when the capitellum is completely ossified and occurs in older boys.
3. In Panner's disease, there is re-establishment of blood flow and thus the capitellum heals without long term deformity. In OCD, a free fragment may result.