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CFO
UCL
Ulnar N
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Anatomy
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Medial
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The important anatomical structures in the medial aspect of the elbow include the four flexors, pronator teres and brachialis. Beginning from posterior, flexor digitorum profundus and flexor digitorum superficialis are separated by flexor carpii ulnaris. Flexor carpii ulnaris has two heads arising either side of the ulnar groove. Flexor digitorum superficialis (FDS) separates flexor carpii ulnaris (FCU) from the flexor carpii radialis (FCR). The principle muscle bulk anteromedially is from pronator teres and the adjacent brachialis. The principle nerve on the medial side is the ulnar nerve. patients with CFO enthesopathy have a characteristic symptom of medial elbow pain exacerbated by flexion against resistance. Clinically the pain is said to occur a little more proximal than symptoms due to ulnar collateral ligament sprain. The best known sport associations are golf when the trailing (dominant) arm is most effected. It also occurs in high-performance athletes, particularly in sports requiring repetitive valgus and flexion forces at the elbow such as tennis, racquetball, baseball pitching, javelin, football, archery and swimming.Patients present with chronic medial elbow pain, exacerbated by activities requiring resisted flexion of wrist and pronation of the forearm. On physical examination, patients have point tenderness over the common flexor tendon, which is made worse by resisted wrist flexion.
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Coronal fat saturated proton density or STIR images are the mainstay for diagnosis of this common condition. The entity is also termed flexor pronator muscle sprain and principally involves flexor carpii radials and pronator trees. An examination of axial MR sections show that these are the principal tendinous components on the medial side and it will therefore be unsurprising that they are most often affected by enthesopathy. The principle imaging findings are disorganisation of the tendinous common flexor origin with high signal replacing the normal low signal tendon on fat saturated and T2 weighted images. T1 weighted images also show signal heterogeneity replacing the normal low signal tendon, however the impact of magic angle phenomenon should be considered prior to making a diagnosis based on T1 weighted images alone. Axial images provide supportive findings.
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