Improved magnetic resonance imaging visualization of the medial collateral ligament with elbow flexion

Because of the small size and oblique orientation, arm position is an important factor in accuracy of magnetic resonance imaging (MRI) evaluation of the anterior bundle of the medial collateral ligament (MCL) of the elbow. The purpose of this study was to determine whether elbow flexion improves visualization of the anterior bundle. Evaluation on the effect of arm position on MRI visualization of the anterior bundle was initially conducted in a cadaveric arm with the proximal and distal attachments of the anterior bundle verified through anatomic dissection. The influence of arm position on MCL visualization was subsequently studied in 5 volunteers using high-resolution 3.0 T MRI. Optimal visualization of the anterior bundle, with the proximal and distal ligament attachment visualized on 1 coronal MRI slice, was achieved by placing the arm in a simple positioning device that held the arm in full forearm supination and 30 degrees of elbow flexion. Positioning the forearm in full supination and 30 degrees of elbow flexion using a simple positioning device increased the reproducibility of images, potentially improving accuracy of diagnosis of partial thickness MCL tears, and minimizing the nondiagnostic scans obtained when evaluating these patients.