Elbow Ultrasound
Examination Technique
http://www.slideshare.net/abd_ellah_nazeer/presentation1pptx-ultrasound-examination-of-theelbow-joint
Royal Imaging
May 2015
Volume 1, Issue 1
Our practice offers diagnostic imaging services
Table of Contents
The Purpose and Benefit of the booklet........................................ 3
Anatomy of the Elbow ................................................................... 3
Examination Protocol .................................................................... 4
Patient Position ............................................................................. 5
Examination Technique ................................................................. 8
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The Purpose and Benefit of the Booklet
This booklet outlines the Examination Technique for an Elbow
Ultrasound. It is aimed for use by all Sonographers mainly trainees
in musculoskeletal ultrasound and new Sonographers to the
practice. The benefits of this booklet include easy quick review to
elbow ultrasound examination protocol with access to anatomy and
expected normal ultrasound appearance.
It also aimed at
promoting high competency levels in performing the examination.
Anatomy of the Elbow. (Jacobson 2007, 102)
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A synovial joint; Proximal ends of radius and ulna and distal
humerus.
Composed of 3 articulations; the radio-capitellar, Radioulna and Trochlea-ulna. These are stabilized by soft tissue
structures and anterior position of the capsule.
Anterior aspect
Branchialis inserts on the ulna
Biceps branchii tendon inserts on the radioal tuberosity
Medial aspect
Common flexor tendon which originates on the medial
epicondyle of the distal humerus.
Lateral aspect
Common extensor tendon originates at the lateral
epicondyle of the distal humerus.
Posterior aspect
The triceps branchii inserts on the olecranon process of the
proximal ulna.
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Space between the olecranon process of the ulna and the
medial epicondyle is bridged by the cubital tunnel and
contains the ulna nerve.
http://www.aafp.org/afp/2000/0201/p691.html
Examination protocol (Study Guide 2013, 10)
Anterior o Radio-capitellar joint – long include annular recess
o Trochlear-coranoid joint –long
o Distal humeral cartilage – trans
o Distal biceps tendon – long and trans
o PIN trans and long at the Arcade of Frohse
Lateral o CETO – 3 long anterior – lateral – includes radial collateral
ligament.
o CETO long with colour – gentle pressure
o CETO - trans
o Dual CETO – Rt and Lt with measurements in long.
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Medial o CFTO long and Trans
o Ulnar collateral ligament
Posterior o Triceps insertion
o Triceps muscle including posterior recess
o Ulna nerve long
o Ulna nerve trans – arm flexed and extended to assess for
sublaxation of the nerve out of the groove.
Patient Position (European Society of Musculoskeletal Radiology)
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Lateral aspect: Common Extensor Tendon.
Patient position
probe orientation
Normal ultrasound image
http://www.ultrasoundcases.info/Protocol-View.aspx?cat=553&case=4634
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With patient’s arm extended and thumb up, the tendon is
examined on its longitudinal axis using coronal plane.
Transverse images should be taken at the insertion.
The Radial collateral ligament may be seen but difficult to
separate it from the common extensor tendon.
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Anterior aspect: Distal Biceps and elbow joint
Probe orientation
Normal ultrasound image: Elbow Joint & distal biceps
http://www.ultrasoundcases.info/Protocol-View.aspx?cat=553&case=4634
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Ensure that distal half of the probe is gently pushed against the
patient’s skin to ensure parallelism between the ultrasound beam
and the distal biceps tendon to adequately show the fibrillar
pattern of the tendon.
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To find the PIN, use an anterolateral approach in transverse starting at the
elbow crease and the PIN can be seen ‘in’ the supinator muscle. Evaluate
in short axis and longitudinal.
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Medial aspect: Common Flexor Tendon.
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Patient position
probe orientation
Normal ultrasound image
http://www.ultrasoundcases.info/Protocol-View.aspx?cat=553&case=4634
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Patient lies in ipsilateral side with the forearm in forceful
external rotation with elbow slightly flexed.
The probe is placed over the medial epicondyle as shown in
picture B above. The Common flexor tendon origin can be
seen as shown in picture C and deep to this tendon, the
ulna collateral ligament may also be visualized.
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Posterior aspect: Triceps Tendon and Ulna Nerve.
Patient position
image
probe orientation
Normal ultrasound
http://www.ultrasoundcases.info/Protocol-View.aspx?cat=553&case=4634
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With palm resting on the table, and elbow flexed, triceps
tendon can be visualized and examined as per protocol.
Ensure the table is lowered enough for patient’s comfort
taking note of the shoulder position.
The cubital tunnel maybe examined in this position with
probe more medially in transverse. The picture below
shows a normal ulna nerve.
http://www.ultrasoundcases.info/Protocol-View.aspx?cat=553&case=4634
Examination Technique
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No preparation is required for this examination
Patient history and referral should be read and details
confirmed with patient.
A high frequency linear probe, 17MHz is most suitable for
most patients because structures to be examined are quite
superficial although a 12MHz may be used for the anterior
elbow on large patients.
The entire examination may be completed with the patient
sitting directly opposite the examiner with the arm stretched
out supine on the examination table. Jacobson (2007, 102)
says that the evaluation of the elbow may be focused over
the area that is clinically symptomatic but through my training
I have been encouraged to carry out a complete examination
of the entire elbow as per given protocol to develop an
efficient sonographic scanning technique.
Dual or split screen may be used for comparison with
contralateral side.
Minimum pressure is used to avoid masking of pathology
especially when using Colour Doppler.
References:
 Jon A., Jacobson. 2007.
Fundamental of Musculoskeletal
Ultrasound. 1st edition. USA. Elsevier Saunders.
 Stefano Bianchi and Carlo Martinoli. 2007. Ultrasound of the
Musculoskeletal System. New York. Springer.
 Lee-Anne Grimshaw. 2013. Musculoskeletal Sonography and
Advancements in Ultrasound; Study Guide. Curtin University.
Perth.
 Ultrasoundcases.infor. Accessed May 2015 from
http://www.ultrasoundcases.info/Default.aspx
 European Society of Musculoskeletal Radilogy. Musculoskeletal
Ultrasound Technical Guidelines II. Elbow. Accessed May 2015
from http://www.essr.org/html/img/pool/elbow.pdf
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29 Prince Street
Athlone
Perth, WA 6429
Phone (08) 9522-4209
Fax (08) 9522-4210
www.royalimaging.com.au