Stephen Bird

Hi Ray,

You raise a great point as we need to attempt to classify these echogenic areas correctly as with enthesophytes, avulsions, loose bodies, osteophytes, exostosis, crystal deposition etc.

By definition an avulsion is where a piece of bone at an enthesis is pulled off by a traumatic overloading of the tissue attached at the enthesis.
Depending on the location it may be caused by the joint capsule attachment (ligament) , tendon attachment, retinaculum attachment or plantar / volar plate attachment. In all of these cases you should see a relationship between the disrupted collagen and the fragment of bone avulsion.

A loose body on the other hand is usually associated with chronic OA and it is a piece of bone / cartilage that has chipped off as part of the OA process and is not related to a collagen enthesis attachment point but rather is in an intra-articular location.

What is it in your case?

It is difficult for me to be absolutely sure and a plain radiograph will certainly help.

It could be a small loose body jammed under the radial collateral ligament.

It could also be a small traction enthesophyte,

There is certainly some vascularity in the joint capsule suggesting a degree of synovitis of the joint.

Great case Ray,


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