<b>Introduction: </b>The elbow is a superficial joint, particularly exposed to direct impact, forced movement, and overstrain. Our work aimed to study magnetic resonance imaging (MRI) pathologies of the soft tissues of the elbow through illustrative cases. <b>Methodology:</b> This was a retrospective and prospective cross-sectional study covering a period of one year, from June 2020 to June 2021, at the Saint Camille Hospital in Ouagadougou and the Polyclinique Notre Dame de la Paix. <b>Results:</b> In general, this study found that the pathologies diagnosed on MRI were lateral epicondylitis, subcutaneous type V elbow lipoma and liposarcoma, anteromedial cortical fracture of the radial cup, cortical detachment fracture of the lateral epicondylitis, medial epicondylitis, villonodular articular synovitis, simple dermo-hypodermatitis, sequellar fibrosis of the ulnar nerve, Workman's syndrome (median and ulnar nerves) and osteoarthritis of the elbow. Lateral epicondylitis was the most frequent pathology, and most patients consulted for elbow pain predominantly associated with pressure on the epicondyle, with relative functional impotence and, occasionally, elbow swelling. <b>Conclusion:</b> MRI, as a complement to ultrasound and radiography, remains the most informative examination for exploring soft-tissue pathologies of the elbow.
The elbow is a superficial joint, particularly exposed to direct impact, forced movement, and overload. It’s a complex joint made up of three articulations: the humero-radial, humero-ulnar, and proximal radio-ulnar joints, all surrounded by a single synovial sleeve. These three congruent joints are held together by various capsulo-ligamentary and musculo-tendinous structures, ensuring stability during movement [
· A very precise anatomical and lesion definition,
· Assess the injury mechanism,
· Guide management [
We therefore propose to study MRI pathologies of the soft tissues of the elbow through illustrative cases.
This was a cross-sectional study with retrospective and prospective data collection, carried out at the Polyclinique Notre Dame de la Paix (PNDP) and Hôpital Saint Camille de Ouagadougou (HOSCO). It lasted one year, from June 2020 to June 2021.
Our study population was made up of patients referred to the radiology and medical imaging department for MRI.
All patients with a traumatic or non-traumatic indication for an MRI of the elbow were included in the study.
All patients who gave their consent and underwent an MRI of the elbow were included in the study.
The study did not include any altered or incomplete MRI records for which the indication could not be provided.
The variables collected were:
· Age and gender;
· Profession;
· Nationality;
· Prescriber;
· Circumstance of occurrence;
· Functional signs;
· Examination quality;
· Lesion site;
· Pathologies found.
Data were collected confidentially, using an individual data collection form with appropriate variables, entered, and analyzed using Microsoft Excel software. These forms were completed after reading the MRI scans of the elbow.
We performed a descriptive analysis of the variables collected in the form of pro-portions.
A total of 13 patients were selected for the study. The mean age of patients was 40 ± 2.75 years, with extremes of 19 and 61 years. The population aged between 20 and 40 represented 92.3% (n = 13). The male population represented 53.84% and the female 46.15% of patients, i.e. a sex ratio of 1.16. The absence of any notion of elbow trauma was noted in 53.84% of patients, and the notion of trauma in 46.15% of patients (n = 13). By nationality, nine patients (69.77%) were Burkinabe, and four patients (30.23%) were expatriates. The distribution of patients by prescriber is shown in
About the different occupations, 46.15% of patients were mining civil servants.
The distribution of patients according to the functional signs that prompted MRI is shown in
| Prescribers | Frequency | Percentage (%) |
|---|---|---|
| Rheumatologists | 5 | 38.46 |
| General practitioners | 2 | 15.38 |
| Orthopedic physicians | 4 | 30.76 |
| Surgical health attaché | 1 | 7.69 |
The distribution of patients according to the location of the various lesions is shown in
A 35-year-old sportsman and civil servant in the mines, consulted for mechanical pain of the left elbow without functional impotence, with persistent pain despite oral treatment.
| Prescribers | Frequency | Percentage (%) |
|---|---|---|
| Mining officials | 6 | 46.15 |
| Retailers | 3 | 23.07 |
| Radiologist | 1 | 7.69 |
| Factory worker | 2 | 15.38 |
| Student | 1 | 7.69 |
| Functional symptoms | Frequency | Percentage (%) |
|---|---|---|
| Mechanical and chronic pain | 6 | 46.15 |
| Inflammatory and chronic pain | 7 | 53.84 |
| Moderate impotence | 6 | 46.15 |
| Ankylosis | 3 | 23.07 |
NB: The same patient may present several functional symptoms.
| Pathologies | Frequency (n) |
|---|---|
| Nerve damage: -Sequential fibrosis of the ulnar nerve -Workman’s syndrome (median and ulnar nerves) | 02 |
| Villo-nodular articular synovitis | 01 |
| Simple dermo-hypodermatitis | 01 |
| Medial epicondylitis | 02 |
| Lateral epicondylitis | 03 |
| Subcutaneous type V lipoma and liposarcoma of the elbow | 02 |
| Osteoarthritis of the elbow | 01 |
| Normal | 01 |
| Anteromedial cortical fracture of the radial cup | 01 |
| Cortical detachment fracture of the lateral epicondyle | 01 |
NB: The same patient may present with several pathologies.
During the study period, three cases of lateral epicondylitis were encountered (right elbow: 2 patients and left elbow: 1 patient), two of which were associated with traumatic lesions. One patient had a history of SC hemoglobinopathy and radial bone infarction and presented with bilateral epicondylitis. Most patients consulted for elbow pain, predominantly on epicondylar pressure, associated with relative functional impotence, and occasionally, elbow swelling. In one case, the radial collateral ligament and lateral ulnar collateral ligament were affected.
On MRI, T1, T2, and fluid-attenuated inversion recovery (FLAIR) hypersignal abnormalities are seen in the common tendon of the lateral epicondyle muscles. In some cases, a liquid-type hypersignal may be present, in connection with a tendon rupture [
A 19-year-old female patient with no pathological history, was seen for firm well-limited soft-tissue swelling of the elbow with chronic inflammatory pain. Her images are shown in
Two cases of lipomatous lesions were also found (one simple with benign features and another complex with several signs of malignancy). This was a grade V liposarcoma according to the World Health Organization (WHO) classification.
Liposarcomas are classified into five WHO subtypes: well-differentiated, differentiated type, myxoid, pleomorphic, and mixed. These tumors are very rarely associated with neurofibromatosis, representing the most serious complication of this disorder [
A 42-year-old patient presented with a long-standing (8-months) trauma to the right elbow, presenting with mechanical pain with moderate functional impotence and a sensory-motor deficit in the ulnar nerve territory (weakness of thumb-index pinch).
On MRI, the main signs to look for are abnormalities in size and shape, as well as signal modification, which is variable. MRI can also be used to identify denervation lesions, showing hypersignal of muscle masses. MRI helps to distinguish between axonotmesis (possible nerve regeneration) and neurotmesis (definitive lesion). In the case of axonotmesis, muscle hyperintensity peaks in three to four weeks and then diminishes in six to eight weeks with functional recovery of the muscle. In the case of neurotmesis, the hypersignal persists
beyond six to eight weeks. Muscle atrophy and fatty degeneration, best visualized in T1-weighted sequences, occur in cases of chronic denervation and are an indicator of irreversible muscle damage. MRI not only has a prognostic role but also a topographical one, by pinpointing the precise muscular distribution of denervation [
A 33-year-old shopkeeper, presented with chronic swelling, mechanical pain, and ankylosis of the left elbow suggesting chronic synovitis on ultrasound. His images are shown in
Villonodular Synovitis (VNS) is a rare benign condition with an estimated annual incidence of 1.8 cases per million populations. It occurs mainly in young adults between the 3rd and 5th decade, as in our patient, and both sexes are equally affected. The etiopathogenesis of SVN remains unknown, but various hypotheses have been put forward: a local disorder of lipid metabolism, inflammatory synovial hyperplasia, repeated trauma, and hemorrhage. A distinction is made between localized forms affecting the joints, bursae, and tendon sheaths, and diffuse, mainly intra-articular forms. Localized forms account for 77% of
cases, mainly affecting the knee. Diffuse forms of SVN mainly affect the knee in 66% - 80% of cases, the hip in 4% - 16%, then the ankle, shoulder, and finally the elbow. Localization to the elbow is very rare (25 cases reported in the literature) [
A 39-year-old female patient with known diabetes, was seen for inflammatory-type swelling and pain with moderate functional impotence of the right elbow.
A 39-year-old female patient was seen for mechanical elbow pain with moderate functional impotence and had a history of trauma one month ago. Her images are shown in
A 39-year-old female radiologist, AS hemoglobinopathic, came with chronic
inflammatory pain of the left elbow with moderate functional impotence.
A 32-year-old patient was seen for chronic mechanical pain of the left forearm and bursitis demonstrated on ultrasound. His images are shown in
A 61-year-old patient was admitted for right elbow trauma with mechanical pain, functional impotence of the left thoracic limb, and ulnar nerve compression syndrome (paresthesia of the 5th finger).
MRI, as a complement to ultrasound and radiographic assessment, remains the most informative examination for exploring soft-tissue pathologies of the elbow. Our atlas consisted of images of the main pathologies found in our context, dominated by epicondylitis, some of which were associated with traumatic and
non-traumatic bone lesions. These were followed by subcutaneous lipomatous lesions, namely lipoma and liposarcoma. Villonodular synovitis, ulnar tunnel syndrome, and elbow dermo-hypodermitis were lesions found in our study, whose images, through several sequences, provided a good understanding of these pathologies. The protocols used were those established by the French College of Radiologists. However, non-systematic sequences (gradient echo, diffusion, and gadolinium injection) were used specifically according to the lesion found. Pain, the most frequent reason for consultation, was most often chronic, having previously motivated other radiological modalities (standard radiography, ultrasound). MRI of the elbow remains a rare indication in our context, which explains the size of the study population, but it remains the best indication for all chronic elbow conditions.
The authors declare no conflicts of interest regarding the publication of this paper.
Some, M.J.M., Ouedraogo, P.A., Tankoano, A.I., Congo, J.W., Kindo, B., Kambou, B.M.A. and Cisse, R. (2024) Atlas of Elbow Soft Tissue Pathologies Using Magnetic Resonance Imaging at the Saint Camille Hospital in Ouagadougou and the Polyclinique Notre Dame de la Paix (Burkina Faso). Open Journal of Medical Imaging, 14, 43-55. https://doi.org/10.4236/ojmi.2024.142004