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Case 9983
Isolated traumatic rupture of the brachialis muscle in a
9-year-old girl
Vijdea RL, Al-Aubaidi Z, Torfing T
Musculoskeletal System Section:
2012, May. 7 Published:
9 year(s), femalePatient:
Authors' Institution
Odense University Hospital,
Sdr. Boulevard 29,
5000 Odense, Denmark
Email: radu.vijdea@ouh.regionsyddanmark.dk
Clinical History
A 9-year-old girl presented at the Emergency Room after she fell on her left elbow during a soccer
game at school. Besides pain in the elbow, she presented with her elbow in a 90 degrees flexion
with diffuse swelling and tenderness.
Imaging Findings
Initial elbow X-ray showed moderate intraarticular effusion without fractures. MRI of the elbow
showed no sign of fracture, but confirmed the effusion in elbow joint previously seen on the X-ray
examination. Furthermore it showed severe signal changes in the brachialis muscle, representing an
almost complete rupture of the brachialis muscle fibres.
Discussion
Background: Among elbow injuries in children, fractures and dislocations are the most common
type, where as muscle tears are particularly rare in this age group. Tears of the biceps muscle
represent the most frequent muscle injuries around the elbow, while isolated tears of the brachialis
muscle are very rare [1, 2]. Review of the literature shows that only few cases of brachialis muscle
tears have been reported [3]. These are mainly adults or teenagers, who are particularly active in
different sport disciplines [4], or were even elite sportsmen [5].
Clinical Perspective: Fractures around the elbow are the most frequent traumatic injury of this
region in children, while muscle tears are uncommon in this age group.
Imaging Perspective: In some previously reported cases of brachialis muscle injuries, the patients
could attribute the injury to a particular sports activity, but without knowledge of a specific moment
when the injury may have occurred. That's why in some of these cases a neoplasm was initially
suspected on MRI [4]. In our case the patient could easily relate the trauma to the practiced sports
activity and she could precisely point out the time of accident. Furthermore the MRI report showed,
without any doubt, an almost complete tear of brachialis muscle.
An anterioposterior and lateral view X-ray is the standard modality for diagnosing such an injury.
The presence of joint effusion in an acutely injured paediatric elbow should be considered evidence
of fracture until proved otherwise [6]. MRI is known as the golden standard in diagnosing soft
tissue injuries in adults, and it should be considered as a diagnostic modality in children and
adolescents trauma as well [7].
Outcome: After 2 weeks treatment with the cast, the patient had some pain from active movement
of the elbow. At the last follow up after 6 weeks, the patient was pain free normal range of
movements of the elbow.
Take Home Message, Teaching Points: Although they are rare, muscle tears in children can be a
diagnostic challenge for X-ray in the acute phase. Therefore MRI in the sub acute phase should be
considered. The use of open MR scanners can increase children's compliance and thus better
diagnostic results in this age group. To the best of our knowledge, brachialis muscle tear in young
children is not described in the literature.
Final Diagnosis
Complete rupture of the left brachialis muscle
Differential Diagnosis List
Supracondylar fracture, Muscle tumour
Figures
Figure 1 MRI of the left elbow (coronal PDW)
MRI of the elbow (coronal PDW) shows complete rupture of the brachialis muscle.
© Torfing T., Radiology Department, Odense University Hospital, Odense, Denmark
Area of Interest: Trauma;
Imaging Technique: MR;
Procedure: Diagnostic procedure;
Special Focus: Trauma;
Figure 2 MRI of the left elbow (sagittal STIR)
MRI of the elbow (sagittal STIR) shows complete rupture of the brachialis muscle.
© Torfing T., Radiology Department, Odense University Hospital, Odense, Denmark
Area of Interest: Trauma;
Imaging Technique: MR;
Procedure: Diagnostic procedure;
Special Focus: Trauma;
MeSH
[A01.378.800.420]Elbow
[E01.370.350.500.510]Magnetic Resonance Imaging, Cine
A type of imaging technique used primarily in the field of cardiology. By coordinating the fast
gradient-echo MRI sequence with retrospective ECG-gating, numerous short time frames evenly
spaced in the cardiac cycle are produced. These images are laced together in a cinematic display so
that wall motion of the ventricles, valve motion, and blood flow patterns in the heart and great
vessels can be visualized.
References
[1] Do T, Herrera-Soto J (2003) Elbow injuries in children Curr Opin Pediatr 15:68-73
[2] Griffith JF, Roebuck DJ, Cheng JCY, et al (2001) Acute elbow trauma in children: Spectrum of
Injury Revealed by MR Imaging Not Apparent on Radiographs AJR Am J Roentgenol 176:53-60
[3] Van den Berghe GR, Queenan JF, Murphy DA (2001) Isolated rupture of the brachialis: a case
report J Bone Joint Surg Am 83-A:1074-5
[4] Nishida Y, Tsukushi S, Yamada Y, et al. (2007) Brachialis muscle tear mimicking an
intramuscular tumor: a report of two cases J Hand Surg 32A:1237-1241
[5] Wasserstein D, White L, Theodoropoulos J. (2010) Traumatic brachialis muscle injury by elbow
hyperextension in a professional hockey player Clin J Sport Med 20:211-212
[6] Gómez JE (2002) Upper extremity injuries in youth sports Pediatr Clin North Am 49:593-626
[7] Emery KH. (2006) Imaging of sports injuries of the upper extremity in children Clin Sports Med
25:543-68
Citation
Vijdea RL, Al-Aubaidi Z, Torfing T (2012, May. 7)
Isolated traumatic rupture of the brachialis muscle in a 9-year-old girl {Online}
URL: http://www.eurorad.org/case.php?id=9983
