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MRI Features of Posterior Capitellar Impaction Injuries

Zehava Sadka Rosenberg1, Salomon I. Blutreich2, Mark E. Schweitzer1, Jonathan S. Zember3 and Kevin Fillmore1

1 Department of Radiology, NYU Hospital for Joint Diseases, 6th Floor, 301 E 17th St., New York, NY 10003.
2 Department of Medicine, Saint Vincent Catholic Medical Center, New York, NY.
3 Medical School, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.


Figure 1
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  		Fig. 1A —31-year-old man with history of posterolateral elbow pain. Diffuse edema (asterisk) is seen in posterior capitellum and distal humerus on sagittal T1-weighted MR image (TR/TE, 500/14) (A) and sagittal T2-weighted fat-suppressed image (4,000/50) (B).

 

Figure 2
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  		Fig. 1B —31-year-old man with history of posterolateral elbow pain. Diffuse edema (asterisk) is seen in posterior capitellum and distal humerus on sagittal T1-weighted MR image (TR/TE, 500/14) (A) and sagittal T2-weighted fat-suppressed image (4,000/50) (B).

 

Figure 3
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  		Fig. 2A —91-year-old man after elbow dislocation and collateral ligamentous injuries. Lateral radiograph shows residual elbow subluxation. Crescentic defect in posterior capitellum (arrow) and intraarticular fragments are seen.

 

Figure 4
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  		Fig. 2B —91-year-old man after elbow dislocation and collateral ligamentous injuries. Sagittal T1-weighted MR image (TR/TE, 500/14) shows low-signal posterior marrow edema in capitellar–distal humerus junction (arrow). Contralateral low-signal impaction fracture in radial head (arrowhead) is also noted.

 

Figure 5
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  		Fig. 2C —91-year-old man after elbow dislocation and collateral ligamentous injuries. Coronal STIR image (TR/TE, 6,000/30; inversion time, 150 milliseconds) depicts complete tear at humeral insertion (arrow) of lateral ulnar collateral ligament. Capitellar marrow edema (asterisk) is also noted.

 

Figure 6
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  		Fig. 3A —39-year-old woman with elbow pain after fall off bike and clinical evidence of posterolateral elbow instability. Coronal STIR (TR/TE, 6,000/30; inversion time, 150 milliseconds) (A) and sagittal T2-weighted fat-suppressed (4,000/50) (B) images depict cortical discontinuity, edema, and subchondral arclike increased signal (solid arrow) in posterior capitellum. Disruption of lateral ulnar collateral ligament (open arrow, A) is noted.

 

Figure 7
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  		Fig. 3B —39-year-old woman with elbow pain after fall off bike and clinical evidence of posterolateral elbow instability. Coronal STIR (TR/TE, 6,000/30; inversion time, 150 milliseconds) (A) and sagittal T2-weighted fat-suppressed (4,000/50) (B) images depict cortical discontinuity, edema, and subchondral arclike increased signal (solid arrow) in posterior capitellum. Disruption of lateral ulnar collateral ligament (open arrow, A) is noted.

 

Figure 8
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  		Fig. 4A —31-year-old man after fall from scooter and instability on clinical examination. Sagittal T2-weighted fat-suppressed image (TR/TE, 4,000/50) depicts deformity and edema (asterisk) in radial head consistent with fracture (fracture line visualized on other images). Marrow edema at posterior capitellar–distal humeral junction (arrow) is noted.

 

Figure 9
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  		Fig. 4B —31-year-old man after fall from scooter and instability on clinical examination. Coronal STIR image (6,000/30; inversion time, 150 milliseconds) depicts increased signal (arrows) at humeral origin and distal ulnar insertion of lateral ulnar collateral ligament, consistent with partial tear.

 

Figure 10
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  		Fig. 5 —Linear capitellar impaction injury in 21-year-old man with history of tripping while playing basketball. T2-weighted fat-suppressed image (TR/TE, 4,000/50) depicts posterior capitellar edema (solid arrow) and flattening of subcortical surface (open arrow).

 

Figure 11
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  		Fig. 6A —44-year-old man with lateral elbow pain and MRI evidence of lateral epicondylitis. Coronal T1-weighted MR image (TR/TE, 500/14) depicts partial tears at origins of common extensor tendon (solid arrow) and lateral ulnar collateral ligament (open arrow).

 

Figure 12
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  		Fig. 6B —44-year-old man with lateral elbow pain and MRI evidence of lateral epicondylitis. Posterior capitellar marrow edema (arrow) is noted on more posterior coronal STIR image.

 

Figure 13
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  		Fig. 7A —Normal pseudodefect of capitellum in 45-year-old man. Coronal (A) and sagittal (B) T2-weighted fat-suppressed MR images depict cortical and articular "defects" (arrow) at junction of capitellum with posterior humerus. Note absence of marrow edema in this individual.

 

Figure 14
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  		Fig. 7B —Normal pseudodefect of capitellum in 45-year-old man. Coronal (A) and sagittal (B) T2-weighted fat-suppressed MR images depict cortical and articular "defects" (arrow) at junction of capitellum with posterior humerus. Note absence of marrow edema in this individual.

 

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