Generally seen in three clinical contexts:
• First decade - males - benign outcome
• Second decade - males - true OCD
• Female gymnasts - can shed cartilage fragments over years
Occasionally lateral symptoms have been attributed to thickening of the lateral meniscus/flange, presumed to be secondary to impingement. Apart from pain, patients may present with clicking and snapping. Occasionally this condition can be associated with areas of chondromalacia of the radial head. If symptomatic, the flange is excised and histology has demonstrated synovitis associated with fibrosis. Posterolateral synovial plica (synovial flange) thickening is also described.
Injury is thought to occur when the child is lifted or swung by the parent with the elbow extended. The annular ligament is pulled proximally allowing it to partially slip over the head of the radius. The radius then subluxes or dislocates depending on the extent of the ligamentous injury. In most cases the diagnosis of pulled elbow is made on a combination of clinical history and plain radiography, which shows slight loss of congruity between the proximal end of the radius and the capitellum. This can be difficult to detect in very young children, as the radial head and much of the capitellum have not yet ossified. Occasionally, ultrasound is requested to clarify difficult cases.
Torn with elbow dislocation
RCJ may remain subluxed providing a clue on XR and MRI
