Radiographic Evaluation Routine Views

After taking a history and making a physical examination of the patient, the examining physician may need to make ancillary tests. Routine radiographs remain a very cost efficient initial approach to elbow imaging. They enable the physician to gather formative information on bone, on joint positioning, and on the presence or absence of soft-tissue swelling, loose bodies, ectopic ossification, and foreign bodies. If more information is required, specialized studies, including fluoroscopy, computerized tomography, and arthrography, can be valuable. Initial routine radiographic views include anteroposterior (AP) and lateral views. An AP view is taken with the arm in full extension and the forearm supinated (Fig. 3.19). This position allows good visualization of the medial and lateral epicondyles and of the radiocapitellar joints and the trochlear articulation with the medial epi-condyle. A portion of the olecranon fossa also can be visualized. A lateral view completes the initial examination with two tangential views (see Fig. 3.20). The lateral radiographic view should be taken with the elbow flexed to 90° and the beam reflected distally approximately 70° to account for the normal valgus position of the elbow. The lateral view demonstrates the distal humerus, the elbow joint, and the proximal forearm. It gives an excellent view of the coronoid process anteriorly and the ole-cranon tip posteriorly. If the examiner suspects that the patient has a fracture of the radial head, he or she can obtain an additional view in the lateral position, or the radial head view (Fig. 3.21). This radiograph usually allows for visualization of the head without a view of the overlapping coronoid process. The tube is angled 45° toward the shoulder, the elbow is flexed to 90°, and the

FIGURE 3.19. (A) Patient positioned for anteroposterior (AP) radiographic view. (B) AP radiographic view.

FIGURE 3.19. (A) Patient positioned for anteroposterior (AP) radiographic view. (B) AP radiographic view.

FIGURE 3.20. (A) Patient positioned for lateral radiographic view. (B) Lateral radiographic view.

FIGURE 3.20. (A) Patient positioned for lateral radiographic view. (B) Lateral radiographic view.

thumb is placed in a vertical position. This special view may be indicated if a radial head fracture is suspected after the examiner views the fat pad sign on a plain radiograph.

The elbow joint has both anterior and posterior fat pads that are intercapsular but extrasynovial. Trauma to the joint and increased fluid in the joint push these fat pads away from the bony surface. The appearance of the anterior fat pad on a radiograph sometimes is normal. However, if the posterior fat pad is seen on the lateral radio-

graphic view, it is always abnormal. The appearance of the posterior fat pad, particularly after trauma, may suggest an intra-articular fracture, and additional radiographs or studies may be indicated.

The axial view is another routine radiograph that may be indicated, particularly in throwers. This flexed elbow view (Fig. 3.22) is taken to allow visualization of the posterior compartment, specifically visualization of the articulation of the posterior olecranon and the humerus. The view helps the examiner to evaluate the thrower's elbow

FIGURE 3.21. (A) Patient positioned for radial head radiographic view. (B) Radial head radiographic view.

FIGURE 3.22. (A) Patient positioned for axial radiographic view. (B) Axial radiographic view.

for a posteromedial spur, which is seen in valgus extension overload.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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