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A 61-year-old man with pain in antecubital fossa after an elbow hyperextension injury
  1. J Waterhouse,
  2. C R King,
  3. P Chin,
  4. B B Forster
  1. University of Columbia, Canada
  1. Dr B B Forster, Dept of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5; bruce.forster{at}vch.ca

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CASE HISTORY

A 61-year-old, right-hand dominant man was brought to the emergency department (ED) after catching a heavy object in his left arm and causing a hyperextension injury to his left elbow. He developed acute onset of pain localised to the antecubital fossa. Three days after the injury, he returned to the ED for ultrasonography (US) and stated that since the injury, he had developed significant swelling in the antecubital region. He had also developed pain along the medial side of the upper arm.

On physical examination, the patient was found to be an otherwise healthy man. His left elbow was in a sling and there was minimal swelling over the anterior left elbow. There was tenderness over the medial edge of the biceps muscle belly and a small defect along the medial biceps tendon; however, the distal portion of the biceps tendon was felt to be palpable. Strength on initial exam was grade 5/5 in elbow flexion, but there was decreased forearm supination strength. Neurovascular status was intact.

The patient was referred initially for US (fig 1) and subsequently for MRI (figs 2,3) of the left elbow.

Figure 1

Ultrasonography image of the antecubital fossa.

Figure 2

Sagittal T2 weighted MRI scan of the elbow.

Figure 3

Axial T2-weighted MRI scan through the distal humerus.

QUESTION

What is your diagnosis from the clinical exam and imaging studies?

See page 229 for the answer.

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Footnotes

  • Competing interests: None.

  • Patient consent: Obtained.

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