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Annular Ligament Injury
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Annular ligament: focal thickening of elbow capsule that encircles radial head
              • Attaches to anterior and posterior margins of lesser sigmoid notch of ulna
              • Considered part of lateral collateral ligament (LCL) complex
              • Stabilizes proximal radioulnar joint (PRUJ)
            • Nursemaid's elbow: subluxation or dislocation of radial head out of annular ligament sling in young child

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Hatta T et al: Ligament reconstruction for recurrent anterior dislocation of the radial head. Case Rep Orthop. 2019:6067312, 2019
                                    2. Canton G et al: Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Musculoskelet Surg. 102(Suppl 1):93-102, 2018
                                    3. Feller RJ et al: Snapping at the lateral aspect of the elbow: a case report and review of the literature. JBJS Case Connect. 8(3):e48, 2018
                                    4. Chai JW et al: Ultrasonographic diagnosis of snapping annular ligament in the elbow. Ultrasonography. 34(1):71-3, 2015
                                    5. De Maeseneer M et al: Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol. 84(4):671-81, 2015
                                    6. Mak S et al: MRI of the annular ligament of the elbow: review of anatomic considerations and pathologic findings in patients with posterolateral elbow instability. AJR Am J Roentgenol. 203(6):1272-9, 2014
                                    7. Browner EA: Nursemaid's elbow (annular ligament displacement). Pediatr Rev. 34(8):366-7; discussion 367, 2013
                                    8. Dohi D: Confirmed specific ultrasonographic findings of pulled elbow. J Pediatr Orthop. 33(8):829-31, 2013
                                    9. Richardson M et al: The usefulness of MRI in atypical pulled/nursemaid's elbow: a case report. J Pediatr Orthop. 32(5):e20-2, 2012
                                    10. Husarik DB et al: Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology. 257(1):185-94, 2010
                                    11. Sanal HT et al: Annular ligament of the elbow: MR arthrography appearance with anatomic and histologic correlation. AJR Am J Roentgenol. 193(2):W122-6, 2009
                                    12. Tan JW et al: Pathology of the annular ligament in paediatric Monteggia fractures. Injury. 39(4):451-5, 2008
                                    13. Galik K et al: The effect of the annular ligament on kinematics of the radial head. J Hand Surg [Am]. 32(8):1218-24, 2007
                                    14. Pearson BV et al: Nursemaid's elbow in a 31-year-old female. Am J Emerg Med. 25(2):222-3, 2007
                                    15. Toupin P et al: Radial head subluxation: how long do children wait in the emergency department before reduction?. CJEM. 9(5):333-7, 2007
                                    16. Bozkurt M et al: The annular ligament: an anatomical study. Am J Sports Med. 33(1):114-8, 2005
                                    17. Choung W et al: Acute annular ligament interposition into the radiocapitellar joint in children (nursemaid's elbow). J Pediatr Orthop. 15(4):454-6, 1995
                                    18. Jones J et al: "Irreducible" nursemaid's elbow. Am J Emerg Med. 13(4):491, 1995
                                    19. Earwaker J: Posttraumatic calcification of the annular ligament of the radius. Skeletal Radiol. 21(3):149-54, 1992
                                    20. Frumkin K: Nursemaid's elbow: a radiographic demonstration. Ann Emerg Med. 14(7):690-3, 1985
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Annular ligament: focal thickening of elbow capsule that encircles radial head
                                                • Attaches to anterior and posterior margins of lesser sigmoid notch of ulna
                                                • Considered part of lateral collateral ligament (LCL) complex
                                                • Stabilizes proximal radioulnar joint (PRUJ)
                                              • Nursemaid's elbow: subluxation or dislocation of radial head out of annular ligament sling in young child

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Hatta T et al: Ligament reconstruction for recurrent anterior dislocation of the radial head. Case Rep Orthop. 2019:6067312, 2019
                                                                      2. Canton G et al: Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Musculoskelet Surg. 102(Suppl 1):93-102, 2018
                                                                      3. Feller RJ et al: Snapping at the lateral aspect of the elbow: a case report and review of the literature. JBJS Case Connect. 8(3):e48, 2018
                                                                      4. Chai JW et al: Ultrasonographic diagnosis of snapping annular ligament in the elbow. Ultrasonography. 34(1):71-3, 2015
                                                                      5. De Maeseneer M et al: Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol. 84(4):671-81, 2015
                                                                      6. Mak S et al: MRI of the annular ligament of the elbow: review of anatomic considerations and pathologic findings in patients with posterolateral elbow instability. AJR Am J Roentgenol. 203(6):1272-9, 2014
                                                                      7. Browner EA: Nursemaid's elbow (annular ligament displacement). Pediatr Rev. 34(8):366-7; discussion 367, 2013
                                                                      8. Dohi D: Confirmed specific ultrasonographic findings of pulled elbow. J Pediatr Orthop. 33(8):829-31, 2013
                                                                      9. Richardson M et al: The usefulness of MRI in atypical pulled/nursemaid's elbow: a case report. J Pediatr Orthop. 32(5):e20-2, 2012
                                                                      10. Husarik DB et al: Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology. 257(1):185-94, 2010
                                                                      11. Sanal HT et al: Annular ligament of the elbow: MR arthrography appearance with anatomic and histologic correlation. AJR Am J Roentgenol. 193(2):W122-6, 2009
                                                                      12. Tan JW et al: Pathology of the annular ligament in paediatric Monteggia fractures. Injury. 39(4):451-5, 2008
                                                                      13. Galik K et al: The effect of the annular ligament on kinematics of the radial head. J Hand Surg [Am]. 32(8):1218-24, 2007
                                                                      14. Pearson BV et al: Nursemaid's elbow in a 31-year-old female. Am J Emerg Med. 25(2):222-3, 2007
                                                                      15. Toupin P et al: Radial head subluxation: how long do children wait in the emergency department before reduction?. CJEM. 9(5):333-7, 2007
                                                                      16. Bozkurt M et al: The annular ligament: an anatomical study. Am J Sports Med. 33(1):114-8, 2005
                                                                      17. Choung W et al: Acute annular ligament interposition into the radiocapitellar joint in children (nursemaid's elbow). J Pediatr Orthop. 15(4):454-6, 1995
                                                                      18. Jones J et al: "Irreducible" nursemaid's elbow. Am J Emerg Med. 13(4):491, 1995
                                                                      19. Earwaker J: Posttraumatic calcification of the annular ligament of the radius. Skeletal Radiol. 21(3):149-54, 1992
                                                                      20. Frumkin K: Nursemaid's elbow: a radiographic demonstration. Ann Emerg Med. 14(7):690-3, 1985