Detailed MRI-anatomic study of the lateral epicondyle of the elbow and its tendinous and ligamentous attachments in cadavers.

OBJECTIVE: The objective of our study was to document discrete bone landmarks in the lateral epicondyle of the humerus that represent the "footprints" of those tendons and ligaments that attach to it using MRI-anatomic correlation in cadavers. MATERIALS AND METHODS: Thirty-three dried humeral specimens were inspected to document bone landmarks in the lateral epicondyle. MRI with anatomic correlation was performed in 10 additional cadaveric elbows. The locations of the tendinous and ligamentous attachments to the lateral epicondyle were determined with respect to the same osseous landmarks. RESULTS: The surface of the lateral epicondyle ranged from a flat surface to a surface with up to six discrete landmarks: superior tubercle, anterior tubercle, posterior tubercle, intertubercular sulcus, rough area surrounding the tubercles, and epicondylar ridge. The radial collateral ligament attached to the superior aspect of the intertubercular sulcus and inferior aspect of the superior tubercle and was indistinguishable from the attachment of the lateral ulnar collateral ligament. The extensor carpi radialis brevis, extensor digitorum communis, and extensor digiti minimi had a common origin in the superior aspect of the lateral epicondyle. The extensor carpi ulnaris tendon arose from the posteroinferior aspect of the lateral epicondyle. CONCLUSION: Our investigation documents osseous landmarks that are useful in the identification of the footprints of the tendons and ligaments that attach to the lateral epicondyle. Knowledge of these structures contributes to correct interpretation of MR images in persons with tendinous and ligamentous abnormalities in this region.

Can osseous landmarks in the distal medial humerus be used to identify the attachment sites of ligaments and tendons: paleopathologic-anatomic imaging study in cadavers.

OBJECTIVE: To describe osseous landmarks that allow identification of the attachments of the ligaments and tendons in the distal medial aspect of the humerus. MATERIALS AND METHODS: Reliable osseous landmarks in the distal medial aspect of the humerus were identified in 34 well-preserved specimens from a paleopathologic collection. These osseous landmarks were then sought in magnetic resonance (MR) images of ten cadaveric elbow specimens so that the ease of their visualization and optimal imaging plane could be assessed. To assign these osseous landmarks to specific attachments of the tendons and ligaments in the distal medial humerus, we cut the specimens in slices and photographed and examined them. Subsequently, the prevalence of these osseous landmarks as well as the attachment sites of the tendons and ligaments in this location was determined. RESULTS: We determined ten reliable osseous landmarks in the distal medial aspect of the humerus, their prevalence and ease of identification, and their relationship to the attachments of the tendons and ligaments at the medial distal humerus. CONCLUSION: It is possible to use osseous landmarks at the distal medial humerus to facilitate identification of the different attachments of tendons and ligaments when MR images of the elbow are assessed.

Accessory head of biceps brachii muscle: anatomy, histology, and MRI in cadavers.

OBJECTIVE: The purpose of our study is to describe and define an anatomic variation located close to the bicipital groove using MRI with gross anatomic and histologic correlation in cadavers. MATERIALS AND METHODS: Ten fresh male human shoulders were harvested and used in this investigation. They were derived from persons with a mean age of death of 78.9 years (age range, 58-92 years). MR arthrography using proton density-weighted sequences was used to obtain images in axial, coronal, and sagittal planes. After imaging, the specimens were cut in axial, coronal, and sagittal sections using a band saw. The slices were then photographed to allow correlation with the MR arthrographic images, followed by histologic analysis. RESULTS: Two anomalous tendons, both intimate with the tendon of the long head of the biceps brachii muscle in the bicipital groove, were recognized. The origin of both tendons was in the greater tuberosity near the articular capsule. These structures had a muscular belly that was joined with the other biceps bellies. At the level of the bicipital groove, the anomalous tendons appeared as hypointense structures in proton density-weighted images, with a mostly flat morphology in axial and coronal planes. The average dimensions of these structures were 45.5 (craniocaudal)x6.2 (anteroposterior)x0.85 (mediolateral) mm. CONCLUSION: The MR images, gross anatomic inspection, and histologic information led us to conclude that these anomalous structures were accessory heads of the biceps brachii muscle.