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Abstract
The elbow is a hinge-pivot joint with complex anatomy. It has three bony components and it is surrounded by numerous ligaments, tendons and muscles.
Although the elbow is one of the most stable joints in the body, elbow abnormalities are increasing as the number of people participating in sports is rising.
This however, gave the elbow joint its place in sport medicine, as many cases of elbow joint lesions are due to sport related activities, for example medial and lateral epicondylitis (Golf and Tennis elbow respectively), and muscle tendons tears, plus bony fractures and degenerative diseases as other joints of the body.
Conventional radiographs though widely available and easily interpreted, have many limitations as inability for soft tissue assessments, and missing occult fractures. In contrary to ultrasound where it lacks bony assessment plus it needs highly qualified personnel.
MRI is a newly introduced modality that enables both bony and soft tissue assessments. The rapid evolution of MRI technology with the advent of dedicated surface coils and rapid pulse sequences such as fast spin echo (FSE), and new pulse sequences as STIR images have brought MRI to the forefront of the imaging modalities of elbow joint lesions.
In this study 30 patients with elbow joint lesion randomly referred from orthopedic out patients clinic, were examined by MRI.
Different pulse sequences were used in order to figure out the best imaging protocol for elbow joint and whether or not dedicated pulse sequence or patient position is needed in any given pathology.
In general, T1 weighted images are used to delineate anatomic planes and marrow architecture, as well as, fat content within masses. Bone contusions in fatty marrow are also well depicted with this sequence, while T2 weighted images can detect most pathologic process (tumors, infection, injury) due to their increased fluid content, as fluid appear bright in this sequence.
As fat contents in musculoskeletal system is relatively high, and it appears bright on T1 and T2, a new fat saturation technique was introduced in the field of musculoskeletal MRI which is STIR sequences that results in markedly decreased signal intensity from fat and strikingly increased signal from fluid and edema.
STIR sequences combined with T1 weighted images may be the only way to detect radiologically occult fractures, where fracture line appear as low signal lines in T1 within the marrow and become bright against suppressed background in STIR images.
The same combination is useful in delineating bone marrow edema and bone contusions, they showed low signal in T1 and bright signal in STIR weighted images.
Tendon injuries, representing 33 % of the study cases, are best evaluated in axial and coronal T2-weighted or STIR images, which found to be also the best imaging sequences for muscle injuries, as most of these injuries appear bright in T2 and STIR images.
This combination of T2 and STIR images provided the best definition for olecranon bursitis.
Loose bodies for instance were best seen in T2 weighted images as signal void.