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Posterior Capitellar Injuries Demonstrate Marrow Edema

February 9, 2008
Written by: , Filed in: Musculoskeletal Radiology
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Background
The capitellum can be involved in several different traumatic abnormalities, including Panner’s disease, osteochondritis dissecans, and acute impaction. Furthermore, there is a “pseudodefect” in the posterior capitellum where the capitellum joins the distal humerus.

The objective of a recent study was to describe MRI features of posterior capitellar impaction injuries.

The study has concluded that the capitellar pseudodefect can be distinguished from posterior capitellar impaction injuries by the lack of marrow edema.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

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Results of the Study
In this retrospective review, of 781 elbow MRI examinations, 46 had marrow edema in the capitellum (5.6%).

Five patients had a history of trauma, two had a posterior fracture or dislocation, four had posterolateral rotatory instability on physical examinations, two had lateral epicondylitis, and three had pain.

In 11 patients, bone-bruise-like marrow edema was seen in the posterior capitellum. Two patients had a subchondral linear arc of high T2 signal with discontinuity at the articular surface, one had a subcortical cyst, and one had a subcortical linear signal.

Four patients had flattening of the posterior capitellar articular surface.
Additional findings were bone bruising of the radial head, coronoid process, or olecranon or fractures of the radial head. Nine of the 11 patients had associated collateral ligament tears. In eight cases, the tear was proximal. Two cases had findings compatible with lateral epicondylitis.

Conclusions
Posterior capitellar injuries are infrequently seen in the elbow. They are associated with lateral ulnar collateral and radial collateral ligament injuries and demonstrate marrow edema.

Reviewer’s Comments
The capitellum is susceptible to compression injuries where it impacts against the radial head. This is known as Panner’s disease in young children and as osteochondrosis (OCD) in adolescents, usually found in the anterior capitellum.

Posterior capitellar injuries are commonly associated with other fractures or elbow instability. The study is limited by the small number of cases, retrospective design, and lack of surgical correlation.

Author: Cornelia Wenokor, MD

Reference:
Rosenberg ZS, Blutreich SI, et al. MRI Features of Posterior Capitellar Impaction Injuries.
AJR Am J Roentgenol; 2008; 190 (February): 435-441

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