• take a good history.
• as with any scan, be systematic. treat the elbow as a cylinder. begin laterally then scan the front, medial and posterior aspects.

patient position

patient seated to provide easy access and movement of the elbow.

this can be:

1. on a high swivel chair
2. seated on the side of the bed.
3. seated on a chair opposite the ultrasound bed, facing you with their arm resting on the bed.

lateral elbow 

• for example images of pathology, click here to go to the elbow pathology page.

common extensor tendon (cet) – ‘tennis elbow’:

• flex the elbow.
• put the toe of the probe on the lateral humeral epicondyle with the heel towards to wrist.
• the cet will be a fibrillar echogenic flat topped insertion.

look for:

• convexity indicating swelling (should be flat)
• loss of fibrillar architecture
• calcification
• hyperaemia

radial nerve

• with the arm supinated.
• place the probe transversely, centered on the lateral aspect of the anterior elbow crease.
• the radial nerve is directly beneath.
• follow it proximally around the back of the upper arm.
• then distally into the forearm where it divides into superficial and deep branches.

look for:

• ganglia
• entrapment of the deep branch through the supinator.

radial collateral ligament (rcl)

is difficult to see (as with the ulna collateral ligament).

• is a fan-like band.
• with the elbow flexed.
• the rcl is seen as an extension from the annular ligament around the radial head up to the humerus deep to the cet.

look for:

• absence of the fibrillar architecture

anterior elbow

• for example images of pathology, click here to goto the elbow pathology page.
• have the arm supinated and gently flexed.

joint

• scan in sagittal across the antecubital fossa to assess for a joint effusion.

biceps brachii tendon insertion

• begin in transverse and follow distally
• rotate into longitudinal and follow to the insertion
• you will need pressure on the heel and to angle from the ulna aspect as the tendon dives to insert onto the radial tuberosity.

look for:

• continuous integrity of the tendon from the musculo-tendinous junction to the insertion.

medial elbow 

for example images of pathology, click here to goto the elbow pathology page. 

common flexor tendon (cft)-‘golfers elbow’:

• flex the elbow.
• put the toe of the probe on the medial humeral epicondyle with the heel towards to wrist.
• the cft will be a fibrillar echogenic flat topped insertion.

look for:

• convexity
• loss of fibrillar architecture
• calcification
• hyperaemia

ulna collateral ligament (ucl) is difficult to see (as with the radial collateral ligament).

• is a fan-like band. usually the posterior aspect is affected.
• with the elbow flexed.
• the ucl is seen posterior and beneath the common flexor tendon.

look for:

• absence of the fibrillar architecture

ulna nerve

• with the elbow flexed.
• place the probe transversely, across the olecranon and medial humeral epicondyle.
• the ulna nerve is directly beneath in the ulna groove.
• follow it proximally around the back of the upper arm.
• then distally down to the wrist.

look for:

• ganglia
• subluxation out of the groove during extension. 

posterior elbow

for example images of pathology, click here to goto the elbow pathology page.

•  triceps insertion:
  • place the heel of the probe on the tip of the olecranon tip.
  • assess in longitudinal and transverse.
  • check the integrity of the tendon.

•  olecranon fossa:
  • in longitudinal the dip in the posterior humerus is deep to the triceps.
  • in transverse the lateral borders of the fossa are visible.
  • check for loose calcific bodies or fluid.

•  olecranon bursa:
  • if particularly rounded and swollen, this can be difficult maintain contact to scan.
  • you may need a standoff pad or pile of thick gel over the slightly flexed olecranon tip.
  • the swollen olecranon bursa will be seen as a complex fluid collection over the olecranon tip.
  • usually has increased vascularity.