He tried to straighten his elbow, but it proved to be a “sloppy” mess

This 58-year-old male physical therapist, and world-class athletic trainer, now finds himself in need of rehabilitation. Have a look at the following GIF, and see if you can figure out why he cannot completely straighten his elbow.

Coronal STIR


Q1 (Advanced) – There are two clinical syndromes that are manifested on imaging in this case. Can you name them?

Coronal T1 FSE

Axial STIR

Sagittal PD FSE Fat Sat

Sagittal PD FSE Fat Sat

Coronal STIR


A1 (Advanced) – Image 1, a T1-weighted image, demonstrates a penetrating erosion at the corono-trochlear bump (pink arrow). A subtle fragment of bone or cartilage is indicated by the yellow arrow.

Now have a look at image 2. The blue arrow demonstrates an area of radial chondromalacia that is impacted by an osteochondral defect directly adjacent, and a body that lies between the radius and the humerus.

In image 3, a penetrating defect has produced signal alteration in the radius (pink arrow).

Turn your attention to image 4, and you will see a subtle osteochondral erosion on the humerus (green arrow).

Finally, observe image 5. The pink arrow shows an articular body. The yellow arrow highlights the impaction effect on the radius and its cartilage surface. The green arrows demonstrate inflammation of the common extensor tendon unit, and the adjacent purple arrow shows synovial hypertrophy of the lateral capsule consistent with capsulitis and lateral epicondylitis.

The two syndromes that one might observe on MR that can be translated clinically are:

(a) Lateral epicondylitis syndrome
(b) Sloppy hinge syndrome

The patient has clinical lateral epicondylitis syndrome due to inflammation and microtears of the common extensor mechanism. Go back and review the GIF to see the extensive lateral-sided inflammation both in tendon and soft tissues. This is not the cause for restricted range of motion, though.

The second syndrome is “sloppy hinge syndrome” associated with a loss of the normal smooth undulation of the humerus. Normally the humerus exhibits (a) two depressions, and (b) three bumps which are now interrupted by an osteochondral area of irregularity, and the body that has secondarily damaged the radius preventing full extension of the elbow.


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