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US of the Anterior Bundle of the Ulnar Collateral Ligament: Findings in Five Cadaver Elbows with MR Arthrographic and Anatomic Comparison—Initial Observations¹

¹ From the Departments of Radiology (J.A.J., D.A.J., C.W.H.) and Orthopaedic Surgery (P.J.L.J.), University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910G, Ann Arbor, MI 48109-0326; and Department of Radiology, University of Missouri School of Medicine, Columbia (T.P.). Received April 24, 2002; revision requested June 21; revision received July 30; accepted October 9. Address correspondence to J.A.J. (e-mail: jjacobsn@umich.edu).

View larger version (133K): [in a new window]   Figure 1a. Normal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows normal hyperechoic and fibrillar echotexture (arrowheads) and adjacent hyperechoic fat (solid arrow). Note slight anisotropy (open arrow) where the ligament is oblique to the ultrasound beam. (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show intact ulnar collateral ligament (arrowheads) and adjacent fat (arrow). Low-signal-intensity areas in b represent tissue gas from tissue decomposition.

View larger version (144K): [in a new window]   Figure 1b. Normal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows normal hyperechoic and fibrillar echotexture (arrowheads) and adjacent hyperechoic fat (solid arrow). Note slight anisotropy (open arrow) where the ligament is oblique to the ultrasound beam. (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show intact ulnar collateral ligament (arrowheads) and adjacent fat (arrow). Low-signal-intensity areas in b represent tissue gas from tissue decomposition.

View larger version (146K): [in a new window]   Figure 1c. Normal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows normal hyperechoic and fibrillar echotexture (arrowheads) and adjacent hyperechoic fat (solid arrow). Note slight anisotropy (open arrow) where the ligament is oblique to the ultrasound beam. (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show intact ulnar collateral ligament (arrowheads) and adjacent fat (arrow). Low-signal-intensity areas in b represent tissue gas from tissue decomposition.

View larger version (145K): [in a new window]   Figure 2a. Normal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament (arrowheads) shows normal hyperechoic and fibrillar echotexture. Note broad origin on the undersurface of the medial epicondyle. (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show intact ulnar collateral ligament (arrowheads).

View larger version (142K): [in a new window]   Figure 2b. Normal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament (arrowheads) shows normal hyperechoic and fibrillar echotexture. Note broad origin on the undersurface of the medial epicondyle. (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show intact ulnar collateral ligament (arrowheads).

View larger version (139K): [in a new window]   Figure 2c. Normal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament (arrowheads) shows normal hyperechoic and fibrillar echotexture. Note broad origin on the undersurface of the medial epicondyle. (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show intact ulnar collateral ligament (arrowheads).

View larger version (144K): [in a new window]   Figure 3a. Abnormal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrows) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrows) into the proximal aspect of the ulnar collateral ligament. Arrowhead = normal distal ulnar collateral ligament.

View larger version (143K): [in a new window]   Figure 3b. Abnormal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrows) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrows) into the proximal aspect of the ulnar collateral ligament. Arrowhead = normal distal ulnar collateral ligament.

View larger version (143K): [in a new window]   Figure 3c. Abnormal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrows) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrows) into the proximal aspect of the ulnar collateral ligament. Arrowhead = normal distal ulnar collateral ligament.

View larger version (134K): [in a new window]   Figure 4a. Abnormal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrow) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrow) into the proximal aspect of the ulnar collateral ligament (arrowhead).

View larger version (135K): [in a new window]   Figure 4b. Abnormal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrow) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrow) into the proximal aspect of the ulnar collateral ligament (arrowhead).

View larger version (153K): [in a new window]   Figure 4c. Abnormal ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrow) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrow) into the proximal aspect of the ulnar collateral ligament (arrowhead).