In this section we present typical ultrasound scan planes and identify anatomical structures described in the previous section.
The ultrasound approach usually divides the elbow into four scan surfaces,
located at the anterior,
medial,
lateral and posterior aspects of the elbow.
1.
Anterior aspect of the elbow
Anatomic structures to identify:
-
Biceps brachii,
brachialis and brachioradialis muscles
-
Bicipital and brachial tendons
-
Brachial artery
-
Superficial and deep veins
-
Median and radial nerves
-
Articular surfaces
-
Radiocapitellar joint
-
Coronoid fossa with the corresponding fat pad
Patient positioning - arm extended and the forearm extended in supination (usually over a table ou a pillow placed at the lap).
-
Transverse plane
Fig. 9: Anterior elbow, transverse plane:
Image A - veins collapse with compression, differentiating them from arteries and nerves.
Image B - wider view distal to Image A. [BB - Biceps brachii muscle; B - Brachialis muscle; BR - Brachiradialis muscle; PT - pronator teres muscle (humeral head); Bt - Bicipital tendon; BA - Brachial artery; VC - "vena comitants" of brachial artery (deep brachial veins); MN - Median nerve; RN - Radial nerve.]
2.
Longitudinal plane
Fig. 10: Anterior elbow, longitudinal plane:
Image A - Bicipital tendon inserting at the radial tubercle, note the brachial artery crossing over the tendon from medial to lateral.
Image B - Humero-ulnar joint. Observe the brachialis muscle compressing the fat pad at the coronoid fossa of humerus.
2.
Lateral aspect of the elbow
Anatomic structures to identify:
Patient positioning - elbow extended,
forearm in neutral position and palms held together.
Fig. 11: Lateral elbow, longitudinal plane:
Vertical arrows - common extensor tendon; RCL - Radial collateral ligament; AL - Annular ligament; S - Supinator muscle; LE - Lateral epicondyle; RH - Radial head.
3.
Medial aspect of the elbow
Anatomic structures to identify:
Patient positioning - elbow extended with forearm in external rotation.
Fig. 12: Medial elbow, longitudinal plane:
Vertical arrows - common flexor tendon; Fm - flexor muscles (indistinguishable from each other); UCL - ulnar collateral ligament; ME - Medial epicondyle; U - ulna
4.
Posterior aspect of the elbow
Anatomic structures to identify:
Patient positioning - elbow flexed at 90º with forarm in internal rotation.
Fig. 13: Posterior elbow. Image A - longitudinal plane showing the tricipital tendon's insertion at the olecranon. Note the fat pad at the olecranon fossa.
Image B - transverse plane over the cubital tunnel.
Vertical arrows - triceps tendon; T - Triceps muscle; UN - Ulnar nerve; O - Olecranon; ME - Medial epicondyle; FP - fat pad.