To make the scanning technique of the elbow joint easier to remember it is devided into 4 main parts:
1.
assessment of anterior aspect of the elbow
2.
assessment of medial aspect of the elbow
3.
assessment of lateral aspect of the elbow
4.
assessment of posterior aspect of the elbow.
Fig. 4: Elbow area , Transverse view. During standard ultrasound examination of the wrist four aspects of elbow should be evaluated: anterior, lateral, medial and posterior. In each aspect od the elbow number of anatomical structures should be identified.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
1. assessment of anterior aspect of the elbow
Following anatomical structures should be identified and evaluated:
•Distal biceps tendon
•Anterior coronoid recess (with anterior fat pad)
•Radial nerve (and its deep branch)
•Median nerve
Fig. 5: Anterior elbow. Transverse view. Probe position. (hand supinated)
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Identify and follow median nerve proximally and distally in short-axis view.
Fig. 6: Anterior elbow. Transverse view. A - brachial artery, V - veins. Note that the most "massive" muscle in anterior elbow is the brachialis muscle.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 7: Anterior elbow. anatomy review.
Distal biceps tendon
To obtain the best image place the probe in the longitudinal position,
then move its distal end a little to the radial side (as common distal biceps tendon inserts into tuberosity of the radial bone).
Fig. 8: Distal biceps tendon. Probe position . To obtain longitudinal image of distal biceps tendon move distal end of the probe a bit to the radial side (as the distal biceps tendon inserts into tuberosity of the radial bone)
References: Cyprian Olchowy, Wroclaw Medical University, Poland
In this probe position following image should be obtained
Fig. 9: Distal biceps tendon.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Anterior joint recess
Fig. 10: Anterior joint recess. Probe position. (elbow extended, hand supinated)
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 11: Anterior joint recess. Longitudinal view. As you identify all the stuctures rotate the probe 90 degrees and evaluate this area also in transverse view.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Radial nerve (and its deep branch - posterior interosseous nerve)
Fig. 12: Radial and posterior interosseous nerves. Probe position, transverse view. Probe is placed on the radial side of anterior aspect of the elbow (few cm above elbow joint). Main trunk of radial nerve is identified in its short-axis and then probe is moved distally (From position A to D). Radial nerve divides into two branches : posterior interosseous nerve and cutaneous sensory branch.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 13: Radial and posterior interosseous nerves. Transverse view. Probe is placed on the radial side of anterior aspect of the elbow (few cm above elbow joint). Main trunk of radial nerve is identified in its short-axis and then probe is moved distally (From position A to D). Radial nerve divides into two branches : posterior interosseous nerve and cutaneous sensory branch. Compare the image to the videoloop (fig. 14)
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 14: Radial and posterior interosseous nerves. Transverse view. Probe is placed on the radial side of anterior aspect of the elbow (few cm above elbow joint). Main trunk of radial nerve is identified in its short-axis and then probe is moved distally (From position A to D). Radial nerve divides into two branches : posterior interosseous nerve and cutaneous sensory branch. Compare the image to the Fig.13 where all the anatomical structures seen on the videoloop are identified.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
2.
assessment of medial aspect of the elbow
Following anatomical structures should be identified and evaluated:
•Common flexor tendon
•Medial collateral ligament
Fig. 15: Medial elbow. Probe position. Longitudinal view.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 20: Medial elbow. Longitudinal view. (Common flexor tendon that origins from medial epicondyle of humerus)
References: Cyprian Olchowy, Wroclaw Medical University, Poland
3.
assessment of lateral aspect of the elbow
Following anatomical structures should be identified and evaluated:
•Common extensor tendon
•Radiocapitellar joint
•Radial head,
neck + annular ligament
Fig. 16: Lateral Elbow. Probe position. Longitudinal view
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 18: Lateral elbow. Longitudinal view. (Common extensor tendon)
References: Cyprian Olchowy, Wroclaw Medical University, Poland
4.
assessment of posterior aspect of the elbow.
Following anatomical structures should be identified and evaluated:
•Triceps tendon
•Cubital tunnel + ulnar nerve
Fig. 17: Posterior elbow. Probe and patient position. Longitudinal view of triceps tendon and posterior fat pad are supposed to be identified and evaluated.
References: Cyprian Olchowy, Wroclaw Medical University, Poland
Fig. 19: Posterior elbow. Longitudinal view. Note the location of posterior fat pad and echogenicity of normal triceps tendon
References: Cyprian Olchowy, Wroclaw Medical University, Poland
In most cases ultrasound examination of the elbow is focused to one quadrant of the joint only,
where the clinical symptoms are present.
In this educational exhibit authors presented the protocol for full elbow ultrasound examination.
All the images were obtained on high-performance Toshiba Aplio 500 ultrasound machine using high frequency linear probes (7.2-18 MHz).