Patrick Omoumi MD, Presenter: Nothing to Disclose

Pedro Augusto Gondim Teixeira MD, Abstract Co-Author: Nothing to Disclose

Samuel Richard Ward PhD, Abstract Co-Author: Nothing to Disclose

Debbie Trudell, Abstract Co-Author: Nothing to Disclose

Donald L. Resnick MD, Abstract Co-Author: Nothing to Disclose

To identify, localize and individualize the flexor and extensor tendons as well as the components of the medial and lateral collateral ligaments that attach in the medial and lateral humeral epicondyles, using ultrasonography.

Ten human elbow joints were obtained from 7 fresh frozen cadavers6 males and 1 female, age at death: 58 – 92 years old). Two musculoskeletal radiologists, experienced in musculoskeletal ultrasonography, performed the examinations and evaluated the images in consensus. All structures were examined in both the longitudinal and transverse planes. The examiners sought to differentiate the tendons and ligamentous complexes inserting on the medial and lateral epicondyles using three sets of signs: specific osseous landmarks in the medial and lateral epicondyles, hyperechogenic or hypoechogenic planes, and difference in echogenicity. Anatomic correlation was obtained. Four specimens were sectioned into 3 mm thick slices and Faxitron images of the sections were obtained. Two specimens were dissected by an anatomist following the progressive dissection technique previously described in the literature, scanning all structures before and after they were removed to verify their correct identification by ultrasonography. Ten healthy volunteers were scanned following the same ultrasonographic technique.

These anatomical studies allowed us to confirm the anatomy of the tendons, ligaments and osseous landmarks previously described in the literature as well as their accurate identification by ultrasonography. On the lateral side, the combination of these ultrasonographic signs allowed us to individualize the ECRB and the LCL in 80%, and the EDC/ECM and the ECU in 100% of cases. On the medial side, the FCR and the FDS were individualized in 80%, the FDS and the MCL in 90% and the FCU in 100% of cases.

The combination of the sonographic signs we describe (identification of osseous landmarks, hyper or hypoechogenic lines and difference in echogenicity) allowed to accurately identify and individualize the tendinous and ligamentous structures attaching in the medial and lateral epicondyles in the great majority of cases.

The accurate individualization of these structures may be of interest in defining the extent of pathology preoperatively, as well as for US-guided therapeutic procedures.

Omoumi, P, Gondim Teixeira, P, Ward, S, Trudell, D, Resnick, D, Ultrasonography of the Tendons and Ligaments of the Humeral Epicondyles: An Anatomical Study with Emphasis on Structure Differentiation.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9015033.html