Heterotopic Calcification and Tears of the Ulnar Collateral Ligament
Radiographic and MR Imaging Findings
Susan A. Mulligan1,
Martin L. Schwartz1,
Marc F. Broussard2 and
James R. Andrews3
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.

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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.
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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.
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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).
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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).
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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.
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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.
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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.
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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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