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Heterotopic Calcification and Tears of the Ulnar Collateral Ligament

Radiographic and MR Imaging Findings

¹ Department of Radiology, Health South Medical Center, 1201 11th Ave. S., Birmingham, AL 32505, and Advanced Imaging Associates of Alabama, P.C., P.O. Box 660552, Birmingham, AL 35266.
² Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, 170 E. End Ave. at 87th St., New York, NY 10016.
³ American Sports Medicine Institute and the Alabama Sports Medicine and Orthopaedic Center, 1201 11th Ave. S., Birmingham, AL 35205.

View larger version (136K): [in a new window]   Fig. 1A. —25-year-old male left-handed pitcher with multiple heterotopic calcifications in ulnar collateral ligament. Frontal radiograph (A) and coronal gradient MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of left elbow reveal heterotopic calcifications in intact ulnar collateral ligament (arrowhead, B). No tear of ulnar collateral ligament was identified at surgery. Note hypertrophic spurring of medial compartment.

View larger version (168K): [in a new window]   Fig. 1B. —25-year-old male left-handed pitcher with multiple heterotopic calcifications in ulnar collateral ligament. Frontal radiograph (A) and coronal gradient MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of left elbow reveal heterotopic calcifications in intact ulnar collateral ligament (arrowhead, B). No tear of ulnar collateral ligament was identified at surgery. Note hypertrophic spurring of medial compartment.

View larger version (146K): [in a new window]   Fig. 2A. —Confluent ossification and stalklike appearance of ulnar collateral ligament in 33-year-old male right-handed pitcher. Frontal radiograph (A) and coronal gradient-echo MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of right elbow show ossified ulnar collateral ligament (arrow). Note adjacent small heterotopic calcification (arrowhead).

View larger version (111K): [in a new window]   Fig. 2B. —Confluent ossification and stalklike appearance of ulnar collateral ligament in 33-year-old male right-handed pitcher. Frontal radiograph (A) and coronal gradient-echo MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of right elbow show ossified ulnar collateral ligament (arrow). Note adjacent small heterotopic calcification (arrowhead).

View larger version (144K): [in a new window]   Fig. 3A. —19-year-old male right-handed pitcher with heterotopic calcification and partial tear of ulnar collateral ligament. Frontal radiograph (A) and coronal gradient-echo MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of right elbow reveal 5 x 2 mm proximal heterotopic calcification of ulnar collateral ligament (arrowhead). Note partial tear of ulnar collateral ligament. Contrast material extends inferiorly adjacent to proximal ulna (arrow, B) and beyond distal attachment of ulnar collateral ligament without extravasation. Partial tear of ulnar collateral ligament was confirmed at surgery.

View larger version (168K): [in a new window]   Fig. 3B. —19-year-old male right-handed pitcher with heterotopic calcification and partial tear of ulnar collateral ligament. Frontal radiograph (A) and coronal gradient-echo MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of right elbow reveal 5 x 2 mm proximal heterotopic calcification of ulnar collateral ligament (arrowhead). Note partial tear of ulnar collateral ligament. Contrast material extends inferiorly adjacent to proximal ulna (arrow, B) and beyond distal attachment of ulnar collateral ligament without extravasation. Partial tear of ulnar collateral ligament was confirmed at surgery.

View larger version (100K): [in a new window]   Fig. 4A. —38-year-old male right-handed pitcher with heterotopic calcifications and complete tear of ulnar collateral ligament. Frontal radiograph (A) and coronal gradient-echo MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of right elbow show heterotopic calcification (arrow, B) surrounded by edematous complete tear of ulnar collateral ligament. Contrast extravasation (arrowhead, B) extends into soft tissues adjacent to medial joint space. Complete tear of ulnar collateral ligament was confirmed at surgery.

View larger version (137K): [in a new window]   Fig. 4B. —38-year-old male right-handed pitcher with heterotopic calcifications and complete tear of ulnar collateral ligament. Frontal radiograph (A) and coronal gradient-echo MR image (TR/TE, 450/12; flip angle, 20°) obtained with intraarticular contrast material (B) of right elbow show heterotopic calcification (arrow, B) surrounded by edematous complete tear of ulnar collateral ligament. Contrast extravasation (arrowhead, B) extends into soft tissues adjacent to medial joint space. Complete tear of ulnar collateral ligament was confirmed at surgery.

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