Loose Bodies

Intra-articular bodies sometimes can be difficult to diagnose on radiographs. Some of these bodies are composed of only cartilage, whereas others are ossified but are located deep in the olecranon or coronoid fossa and therefore obscured by superimposed bone structures. CT scans are excellent at showing ossified bodies, but intra-articular contrast (a CT arthrogram) often is necessary for seeing chondral bodies by CT.

Conventional MRI images can show even chondral intra-articular bodies [14], although in patients with only a small amount of fluid in the joint they may be identified only after carefully inspecting the two large humeral fossae. The advantage of MRI over CT is that it also can show marrow edema and extra-articular ligament injury. In some patients, however, even with a well-performed MRI scan it can be difficult to identify a loose body or determine if it is definitely intra-articular. In addition, osteophytes or focal areas of synovial hypertrophy can simulate an intra-articular body on conventional MRI images [14]. If a patient has osteophytes or other issues that may cause difficulty interpreting the MRI, but MRI is preferred over CT because of the superior soft tissue detail, an MRI arthrogram often is able to definitively demonstrate intra-articular bodies (Fig. 8) [15]. In all cases, cross-sectional imaging can provide a roadmap that may be helpful to the surgeon at arthroscopy.

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