Block to extension, supination. Assess for intra-articular chondral lesion, possible physeal fracture (olecranon or medial epicondyle). There is a full-thickness tear of the posterior component of the distal triceps tendon (combined tendon of the lateral and long heads) from the olecranon with mild (1 cm) retraction. There is mild edema within the retracted muscle. A few intact fibers of the lateral aspect of the posterior component may extend to the lateral aspect of the olecranon. The anterior/deep component of the triceps tendon (medial head) can be traced to its insertion on the olecranon although there is edema within its medial fibers which may represent a strain. The lateral aponeurotic expansion appears intact. There is mild edema in the flexor carpi radialis compatible with a strain. The remaining musculature is unremarkable. The biceps and brachialis tendons are intact. The common flexor and extensor tendons are intact.Gadolinium separates the distal aspect of the anterior bundle of the ulnar collateral ligament from the sublime tubercle of the coronoid process, indicating at least a partial thickness undersurface tear, and probably a complete tear of the distal attachment of the ligament. The proximal fibers of the ligament appear intact. The lateral collateral ligament proper and lateral ulnar collateral ligament appear intact.There is edema within the olecranon at the site of triceps avulsion. A small amount of edema is also noted within the tip of the olecranon process corresponding to the site of a small ossicle seen on radiographs; I am not certain if this represents a normal variant accessory ossification center or a small nondisplaced fracture. Additional mild edema is seen more distally within the olecranon as well as in the coronoid process. Edema is also noted within the capitate and radial head which may represent bone contusions. There is a 4 to 5 mm ovoid focus of intermediate signal intensity situated within the joint just distal to the lateral aspect of the humeral trochlea suggestive of a small loose body. It is possible that this arises from a tiny defect in the adjacent trochlea, but this is equivocal; I see no additional cartilage defects.The remaining visualized soft tissue structures are within normal limits.
1.Insertional tear of the triceps tendon as described above.2.Ulnar collateral ligament tear as described above.3.Probable small loose body within the joint.4.Other findings as described above.