Ultrasound of the elbow

Abstract

The elbow is an important synovial hinge joint of the upper extremity. This joint represents a common site of musculoskeletal symptomatology, affecting all age groups. The advantages of ultrasound imaging of the elbow include easy availability, multiplanar capability and the ability to assess structures dynamically. Patient symptomatology and site of maximal tenderness can be directly correlated with imaging findings. Comparison is easily made with the contralateral side. Particular strengths include the ability to assess para-articular structures, such as regional tendons and ligaments, in addition to assessment of joint effusions, loose bodies and regional bursae. With operator experience and excellent technique, ultrasound is a valuable imaging tool for assessment of disorders of the elbow joint.

Sonographic Findings for the Common Extensor Tendon of the Elbow in the General Population

“…These widely differing results are likely to be, at least in part, due to the demands of the technique itself (which is instrument and operator dependent and with a steep learning curve 18 ), the use of different examination protocols (eg, positions of the patient and sonographer, dynamic versus static image assessment, angulation, and transducer position and pressure), the absence of clearly defined epicondylopathy-related alterations that could be expected to be observed on sonography, and the possibility that some of the anomalies detected could also be found in the asymptomatic population (no current or previous pain-related clinical symptoms in the lateral epicondyle). 19 Although we attempted to minimize such biases by using the same instrument operated by the same sonographer, who was blinded to the patient's clinical history, and to perform and evaluate the examination in real time, this study was not free of limitations.…”

Application of Ultrasound and Ultrasound-Guided Intervention for Evaluating Elbow Joint Pathologies

“…A fullthickness tear of the distal biceps tendon presents as a hypoechoic gap between the proximal retracted tendon fragment and the radial tuberosity; in some instances, hematoma can be distally observed. A partial-thickness tear of the distal biceps tendon presents as an abnormal undulation of the tendon fibers without retraction [5]. A complete or partial-thickness tear of the distal biceps tendon may be associated with peritendinous fluid or radiobicipital bursitis [6].…”

“…A triceps tendon injury is usually related to an avulsion fracture of the olecranon process. Hence, the role of ultrasound is to determine the extent and degree of the tear or retraction; any dynamic study using longitudinal scanning during flexion and extension is generally useful [5].…”

“…Common elbow pathologies result from inflammation or injury to the bones and para-articular structures [5]. The use of ultrasound to perform elbow examinations has gained prevalence because of the absence of radiation exposure, accessibility, reduced cost, and the ease of this dynamic examination in comparison with other radiological modalities.…”

Measurement issues in the sonographic assessment of tennis elbow

“…Efforts have been made to produce agreed standards and protocols for musculoskeletal sonographic evaluation, [59][60][61] but these focus on probe and limb positioning and do not address many of the other factors that can affect measurements. Reporting of protocols used in studies also varies substantially, leading to uncertainty about the techniques used.…”