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Tuesday 22nd Jan, 2019

The little things can be important – but how much?

Often what is important, perhaps even more so with advanced imaging is what is normal.

The small bones above are the sesamoids embedded in the tendon of the adductor pollicus longus muscle. This muscle originates on the lateral surface of the proximal radius and ulna, crosses the extensor carpi radialis muscle in the region of the distal radial metaphysis, passes through a tendon sheath, under the medial collateral ligament of the carpus and inserts on the proximal aspect of metacarpal I.

This meant that the ‘medial bone changes’ were not anything to worry about. What was of help however were the other changes seen upon the CT report.

In the left elbow there was an irregular contour to the tip of the medial coronoid process along the subchondral bone of the radial notch. There were also two separate fragments are seen cranial to the medial coronoid process, which were about 1.5mm in diameter. 

The medial aspect of the humeral condyle had a subchondral bone defect opposite to the medial coronoid process (image below, centre). The defect measures approximately 3x3mm, and was surrounded by an area of sclerosis.

Overall, the periarticular margins are very irregular due to severe osteophyte formation. This is mostly seen on the tip of the medial coronoid process, on the sides of the epicondyles, proximal border of the anconeal process and cranial aspect of the radial head (image below, blue arrows)

This information meant that we could better tailor the management plan to address the patient’s needs with a better understanding of the underlying elbow disease and osteoarthritis. 

Next Post: Outpatient Advanced Imaging – CT and MRI

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