Pathology
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Description
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Sonographic Appearance
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Sonographic Image
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ulnar nerve abnormality
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-subluxation-dislocation of the medial triceps belly and ulnar nerve over the medial epicondyle during flexion (repeated friction on dislocation may cause neuritis)
-impingement-due to a thickened retinaculum, ganglion, anomalous anconeus muscle or bony spur |
-subluxation-will see the ulnar nerve move over the medial epicondyle when patient preforms flexion
-impingement-the nerve becomes narrowed at the level of compression and swollen proximally with loss of the normal fascicular pattern |
distal biceps tendon rupture
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-uncommon
-anterior portion of the arm -usually due to attempting to lift a heavy weight -complete rupture of the tendon usually produces an immediate "popping" sensation, pain and a clinically palpable defect |
-a partial tear shows a tick, wavy echogenic tendon that can be followed all the way to the radial tuberosity
-complete rupture of the tendon with muscle retraction will look like a defect in the tendon which may be filled with fluid or hematoma and the retracted tendon edge may be visible -if the aponeurosis is disrupted as well, the retraction of the tendon is greater |
lateral epicondylitis (tennis elbow)
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-due to repetitive microtrauma during supination of the forearm and dorsiflexion of the wrist and results in breakdown of the collagen fibres, with tissue necrosis and fibrosis
-the deep fibres are predominately involved and in few cases the superficial and posterior fibres are involved -a common predisposing cause is playing tennis |
-focal hypoechoic areas superimposed on normal tendon may represent areas of focal degeneration
-diffuse reduction in echogenicity with loss of normal fibrillar architecture can be present and may represent diffuse tendinopathy -anechoic clefts can represent partial or complete tears, tendon swelling may be seen, thickening of peritendinous tissues, foci of calcification in the tendon, a bursa adjacent to the tendon may also be present -the radial collateral ligament may be thickened or torn in severe cases |
medial epicondylitis (golfers elbow)
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-due to repetitive microtrauma
-a common predisposing cause is playing golf |
-virtually the same as those of lateral epicondylitis
-the ulnar collateral ligament may be injured or degenerate |
(Jacobson, 2007)
(McNally, 2005, pg. 87-92)
(McNally, 2005, pg. 87-92)