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Radiology of the Elbow

- See: Radiology of Pediatric Elbow

- Discussion:
      - precise AP & Lateral projections are required to evaluate normal anatomic relationships;
      - there should be no rotation to the forearm;

- AP View:
     - medial and lateral epicondyles and humeral-ulnar/radial articulation;
     - carrying angle;
     - if flexion contracture is present, 2 AP views should be taken, one perpendicular to the forearm and one perpendicular to the humerus;
     - technique: AP
            - forearm is positioned supine (palm up) on the table;
            - elbow joint is fully extended and the fingers slightly flexed;
            - central beam is directed perpendicular to the elbow joint;
            - AP views with the beam perpendicular to the proximal forearm and perpendicular to the distal humerus should be obtained;

- Lateral View:
    - forearm flexed to 90;
    - line from radial head to capitulum;
    - film should demonstrate trochlea & capitellum overlapping w/ space between the humerus and the radial head;
- soft tissue structures:
    - anterior fat pad:
              - superficial part of anterior fat pad should be in front of coronoid fossa;
              - in normal elbow the anterior fat pad should be barely visualized;
                          - look for small radiolucent area between bony rim & moderate opaque shadows of brachialis;
                          - w/ joint effusion (2nd to a minimally displaced radial head frx) there will be anterior & superior displacement of anterior fat pad;
                  - posterior fat pad should not be seen at all;
    - technique:
          - forearm rests on its ulnar side on cassette w/ elbow flexed 90 deg;
          - central beam is directed vertically toward the radial head;

- Internal oblique:
     - trochlear notch of ulna and tip of olecranon process;
     - shows medial epicondyle and coronoid process of ulna;

- External oblique:
     - capitulum and head of radius; proximal radioulnar joint

Radial head-capitellum view: an expanded imaging approach to elbow injury.

Assessment of the radial head-capitellum view and the dorsal fat-pad sign in acute elbow trauma.

Critical evaluation of the radial head-capitellum view in acute elbow with an effusion.

Treatment of traumatic effusion in the elbow joint: a prospective, randomized study of 62 consecutive patients.