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E1330. No Elbow Grease Required: MRI Review of the Post-Surgical Elbow
Authors
  1. Daniel Gardiner; University of Virginia
  2. Nicholas Nacey; University of Virginia
Background
Elbow injuries range from acute derangement to chronic degeneration which are often treated surgically. The operative techniques are complicated and indications for surgery continue to change over time. Our surgical colleagues use history and physical exam in combination with medical imaging to evaluate the integrity of a surgical repair. Magnetic resonance imaging is an invaluable tool in the assessment of the post-surgical construct or ligamentous repair which increases specificity. However, surgical interventions alter the anatomy which makes the interpretation difficult for an inexperienced diagnostician. If not diagnosed and treated effectively, injuries and complications can contribute to significant debilitation and chronic pain for our patients.

Educational Goals / Teaching Points
The objectives of this educational exhibit will be to review mechanisms leading to common injuries; ultimately serving as a background for surgical indications and repair. Overview on current and basic surgical procedures will be described. As a main stabilizer of the elbow and common procedure, there will be particular emphasis on UCL reconstruction (Tommy John Surgery). Additional surgeries discussed will include biceps and triceps tendon repair, RCL reconstruction, ulnar nerve transposition, and common extensor debridement. MR images of the expected post-operative appearance and common complications will be provided.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In general, surgical repairs feature a thickened appearance of the ligaments usually due to over sewing of the native fibers. Mild T2 signal hyperintensity within a ligament repair is typical postoperatively but should normalize after 6 months. However, high-signal or frank disruption of the fibers likely indicates failure. When performed, MR arthrography may increase sensitivity and specificity for undersurface ligament tears and complete tears.

Conclusion
MR imaging in conjunction with physical exam are key tools in the assessment of the elbow. Sufficient knowledge of the expected post-operative appearance and the related complications are necessary for a radiologist to provide accurate diagnoses and to ultimately treat our patients.