Nerve Abnormalities

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MRI may be useful in evaluating patients with nerve disorders at the elbow. Inflammatory changes within a nerve caused by long-standing compression may alter its morphology and signal characteristics on MRI. Normal nerves

Fig. 19. Complete triceps tendon rupture in a 57-year-old male with posterior elbow pain following trauma. Sagittal T2-weighted spin-echo image of the elbow shows a large fluid-filled gap (arrowhead] between the completely torn and retracted distal triceps tendon (arrow) and the olecranon process.

are of intermediate to low signal intensity on all pulse sequences. They have the same signal intensity as adjacent muscle on T1-weighted images. On T2-weighted images, they may have slightly increased signal intensity when compared with adjacent muscle. Inflammation may cause increased signal intensity within the compressed nerve. This increased signal intensity is appreciated best on short tau inversion recovery or fat-suppressed T2-weighted images (Fig. 20). Inflammation also may lead to focal or diffuse thickening of the compressed

Mri Cubital Tunnel Syndrom

Fig. 20. Cubital tunnel syndrome in a 19-year-old baseball pitcher with medial elbow pain and evidence of ulnar neuropathy. (A) Axial Tl-weighted spin-echo image of the elbow shows an enlarged ulnar nerve (arrowhead) within the cubital tunnel. (B) Coronal fat-suppressed T2-weighted spin-echo image of the elbow shows the thickened, edematous ulnar nerve (arrowhead) as it passes posterior to the medial epicondyle. (From Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol 2005;34:1-1 8; with permission.)

nerve. Nerve thickening may be present proximal to and at the site of compression [73,74].

When evaluating patients who have nerve disorders at the elbow, it is important to evaluate the muscles of the upper extremity. Changes in the morphologic and signal intensity of a muscle group may be the only imaging manifestations of an abnormality of the nerve that innervates the muscles. MRI is not reliable at detecting acute denervation of muscle. After a period of approximately one month, however, denervated muscle shows increased signal intensity on short tau inversion recovery images. Chronically denervated muscle demonstrates significant atrophy, variable signal intensity on short tau inversion recovery images, and conspicuous fatty infiltration on T1-weighted images [75].

MRI is most useful at evaluating patients with ulnar neuropathy at the elbow. The ulnar nerve is in a superficial location at the elbow and is surrounded by abundant fat. For this reason it is easy to identify the ulnar nerve at the elbow and to detect subtle changes in its morphology and signal intensity secondary to long-standing compression. MRI has been shown to be helpful at detecting a variety of disease processes related to cubital tunnel syndrome. Compression of the ulnar nerve within the cubital tunnel caused by osteoarthri-tis, posttraumatic deformities, and accessory muscles has been detected using MR imaging (Fig. 21) [73,74].

MRI is less useful at evaluating patients with median and radial neuropathy at the elbow. The median nerve and radial nerve are much more difficult to visualize at the elbow than the ulnar nerve. For this reason inflammatory

Radial Neuropathy

Fig. 21. Cubital tunnel syndrome in a 30-year-old female with medial elbow pain and evidence of ulnar neuropathy. (A) Axial Tl-weighted spin-echo image of the elbow shows replacement of cubital tunnel retinaculum with an anconeus epitrochlearis muscle (arrowhead). (B) Axial fat-suppressed T2-weighted spin-echo images of the elbow in the same location shows the anconeus epitrochlearis muscle (arrowhead) and the adjacent edematous ulnar nerve (arrow) within the cubital tunnel. (From Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol 2005;34:1-18; with permission.)

Fig. 21. Cubital tunnel syndrome in a 30-year-old female with medial elbow pain and evidence of ulnar neuropathy. (A) Axial Tl-weighted spin-echo image of the elbow shows replacement of cubital tunnel retinaculum with an anconeus epitrochlearis muscle (arrowhead). (B) Axial fat-suppressed T2-weighted spin-echo images of the elbow in the same location shows the anconeus epitrochlearis muscle (arrowhead) and the adjacent edematous ulnar nerve (arrow) within the cubital tunnel. (From Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol 2005;34:1-18; with permission.)

changes within these nerves secondary to long-standing compression often are difficult to identify. Nevertheless, MRI may be useful at detecting space-occupying lesions that cause compression of the median nerve and radial nerve at the elbow [73,74,76,77].

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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