CT Arthrography for Demonstration of Radiographically Occult Intraarticular Pathologies in Chronic Post-traumatic Unexplained Painful Elbow

Chronic elbow pain is a not uncommon post-traumatic condition that may be related to a variety of radiographically occult intra-articular pathologies such as synovial hypertrophy, chondral defect, and osteochondral lesion. CT arthrography (CTA) is considered a reliable next-step imaging modality in chronic post-traumatic elbow pain, when the elbow radiograph is normal or non-specific. The aim of the study was to assess the diagnostic performance of CT arthrography of the elbow to detect various radiographically occult pain-producing intra-articular pathologies in chronic post-traumatic elbow pain. Nineteen patients suffered from chronic post-traumatic elbow pain, with a clinical suspicion for intra-articular pathologic changes as chondral defect, osteo-chondral lesion, and synovial hypertrophy underwent CT arthrography of the elbow. The majority of patients demonstrated one or more intra-articular pathologies; the most common finding was the synovial hypertrophy, then the chondral defects. Regarding the location of chondral defects, the capitellar cartilage was the most common affected site. There was significant reasonable positive correlation between VAS scoring and the chondral defects notably the full thickness ones, as well as the synovial hypertrophy and occult fracture; also, there was significant reasonable positive correlation between synovial hypertrophy and chondral lesion regardless of its stage. CT arthrography of the elbow is a valuable imaging technique with proper diagnostic performance for evaluation of different pain-producing intra-articular pathologies in chronic post-traumatic painful elbow.