MyPACS.net: Radiology Teaching Files > Case 5284764

never visited ELBOW, COMMON FLEXOR TENDON TEAR
Contributed by: Radiology Residency Program Faculty & Staff.
Patient: 56 year old male
History: 56 year old male with medial elbow pain and swelling
Images:[small]larger

Fig. 1: Coronal Stir: Abnormal high signal and a complete disruption of the common flexor tendon adjacent to the medial epicondyle. A small joint effusion is noted.

Fig. 2: Coronal Stir: Abnormal high signal and a complete disruption of the common flexor tendon adjacent to the medial epicondyle. A small joint effusion is noted.

Fig. 3: Coronal T1-WI: The underlying ulnar collateral ligament is intact. Mild osteoarthritis is also noted at the radial-capitellum joint.

Fig. 4: Axial Proton Density: Abnormal signal within the common flexor tendon, adjacent to the medial epicondyle.

Fig. 5: Axial Fat Sat T2-WI: Abnormal signal within the common flexor tendon, adjacent to the medial epicondyle. There is overlying soft tissue edema.
Findings:

Coronal Stir shows abnormal high signal and a complete disruption of the common flexor tendon adjacent to the medial epicondyle.  A small joint effusion is noted.  The underlying ulnar collateral ligament is intact, best demonstrated on the coronal T1-WI.
 
Axial PD and Fat Sat T2W sequences confirm abnormal signal within the common flexor tendon.  There is overlying soft tissue edema.

Diagnosis: Complete tear of common flexor tendon at medial epicondyle.
Discussion:

Complete tear of the common flexor tendon can be one the findings at MRI in medial epicondylitis, an overuse tendinopathy of the flexor pronator group (FPG).

MEDIAL EPICONDYLITIS
- Due to chronic valgus stress
- Associated with dominant hand in golf and throwing sports
     - Golfer's elbow
     - Baseball
     - Thrower's elbow
- Best diagnostic clue: thickening and increased signal intensity within flexor pronator group muscle, tnedon at level of medial epicondyle
- Location: FPG origin from the medial epicondyle

MR Findings:
- tendon degeneration, partial tear, tendon disruption, and muscle strain. 
- abnormal signal with possible alteration in tendon thickness on T2W images in tendon degeneration and partial tear.  Discontinuity = complete tear

References:

1. Kaplan, PA. ... [et al.] Musculoskeletal MRI. 1st edition. Saunders, 2001.
2. Stoller, David W. ... [et al.] Diagnostic Imaging: Orthopaedics. Amirsys, 2004.

Submitted by:
Aakash D. Singh, M.D. - PGY-V Radiology Resident
Joseph A. Mendiola, M.D. - Radiologist

Comments:
No comments posted.
Additional Details:

Case Number: 5284764Last Updated: 07-11-2006
Anatomy: Skeletal System   Pathology: Trauma
Modality: MRExam Date: 07-10-2006Access Level: Readable by all users
Keywords: medial epicondylitis, elbow, common flexor tendon tear

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