Other Studies:
Initial three view x-ray of the left elbow revealed no fractures or loose bodies, preserved joint spaces and closed growth plates
(A) Initial AP view plain radiograph of the left elbow. (B) Initial lateral view plain radiograph of the left elbow. Case Photo #7

MR arthrogram of the elbow (ordered after the second visit) showed no abnormalities, no tear of the ulnar collateral, no osteochondral defect Case Photo #8 MRI of the left elbow in coronal view with no visible plica.
MC = Medial Epicondyle, U = Ulna, H = humerus, RH = Radial Head

An issue with the patient's throwing mechanics was offered and investigated with the dynamic MSK ultrasound study. Case Photo #9 The study was crucial in identifying the hypertrophic lateral plica as the source of pain
Longitudinal axis view of the left lateral posterior elbow joint using musculoskeletal ultrasound. (A) View of elbow flexion/extension without impingement. (B) View of elbow flexion/extension with impingement from a hypertrophic lateral elbow plica (asterisk). RH = Radial Head, CAP = Capitellum

Consultations:
After meeting the patient and reviewing the imaging results, the orthopedic surgeon was consulted for possible operative management.

Two weeks later, the patient presented for surgical evaluation. After throwing, he continued to experience sharp pain, feelings of fullness in his lateral elbow and occasionally felt a little popping in the same area. Elbow examination revealed 3 degrees beyond terminal extension of bilateral elbows to 145 degrees of flexion. He had 90 degrees of pronation and supination bilaterally. Stable to dynamic valgus stress. No pain with resisted wrist flexion or extension bilaterally. Negative Tinel's in the ulnar nerve bilaterally, 5/5 strength in radial, median and ulnar distribution bilaterally. On the left side, he did have pain to palpation in the radiocapitellar joint and snapping is reproducible with forced extension and supination.

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