41: Imaging of the Elbow (CRMTOL)
Internal Oblique View of the Elbow
Fully extended, maximally pronated and internal rotated
AP View of Elbow
Has overlap covering up radial head and radial tuberosity so harder to fully see
Normal Alignment in Children
Radio capitellar line and anterior humeral line intersect at capitulum
Year 7
Trochlea begins to ossify
Radiographs in Young Children
A different portion of the arm begins to grow each year
Fat Pad signs
1 big joint capsule for all 3 joints of elbow 1 joint injury causes edema to joint capsule Edema lifts fat bad and creates dark spot near joint
Standard Views of Forearm
AP Lateral Forearm: Fully supinated for both AP and lateral view
Standard Views of Elbow
AP Lateral Oblique: External Rotation
External Oblique View of the Elbow
Best view of radial head and radial tuberosity Position: Fully extended and supinated, arm externally rotated as far at is can go
Year 1
Capitulum begins to ossify
Lateral View of Elbow
Elbow flexed to 90 degrees and forearm fully supinated Very clear look of olecranon and radial head
Year 11
Lateral epicondyle begins to ossify
Radial Head Capitellum View
Looks a lot like lateral view and patient positioned the same Difference: X-ray image shoots at 45-degree angle instead of straight down Want to view radial head, capitulum, and olecranon
Year 5
Medial epicondyle begins to ossify
Radiographic Landmarks
Normal Orientation in Children Fat pad sign: Anterior and Posterior Abnormal supinator line
Year 9
Olecranon begins to ossify
Year 3
Radial head begins to ossify
Anterior fat pad sign
hemarthrosis in radial head fracture More common than posterior