Imaging and other diagnostic techniques

A. Plain radiographs. Plain radiographs of the elbow should include a true lateral and an anteroposterior film. The lateral film is the most difficult to obtain. If a flexion contracture exists, an anteroposterior film of the distal humerus and of the proximal forearm can be helpful. A radiocapitellar view can sometimes be helpful in assessment of the radiocapitellar joint. In the normal elbow, the head of the radius always points toward the capitellum in all views. If an effusion is present, the lateral view may demonstrate displacement of the anterior or posterior fat pad.

B. Bone scans can be useful in an attempt to localize or diagnose pain of unknown origin. A single-phase, "bone static" image may show uptake in a particular region and lead to closer scrutiny.

C. Computed tomography (CT) of the elbow can be useful in fracture and reconstructive problems. It is important to review the clinical history with the radiologist and to describe the area of interest, so that proper angulation of the cuts can be made.

D. Magnetic resonance imaging (MRI). The effectiveness of MRI in detecting a variety of painful conditions is steadily improving. The detail and resolution of images obtained with specialized surface coils permit visualization of ligament, cartilage, nerve, and muscle.

E. Arthrocentesis. As in all conditions of the joints, analysis of joint fluid can be valuable. (Analysis and technique are reviewed in other chapters.) Tapping the elbow requires knowledge of the surface anatomy to visualize effective needle placement.

In addition to synovial fluid analysis, instillation of 1% lidocaine or 0.5% bupivacaine can be diagnostically helpful if the examiner is unsure whether the source of the pain is intraarticular.

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