ELBOW RADIOGRAPHY

BY
NURUDDEEN MOHAMMED B. Rad. (Hons), PGDE.

DEPERTMENT OF MEDICAL RADIOGRAPHY

COLLEGE OF MEDICAL SCINCES

UNIVERSITY OF MAIDUGURI
 Elbow joint
• Elbow joint is a synovial hinge joint formed by
the distal humerus and the proximal radius
and ulna.
It is composed of :
 3 Articulations
 Capsule which encloses the articulation
 Bursa which helps in lubrication
 ligaments
 Indications
• Suspected fractures
• Dislocation/ subluxation
• Foreign body
• Post surgical examination
• Muscular injuries and pathologies
• Tendon injuries
• Foreign body
 Technical factors
• Image receptor: 24x30cm

• 60-65kVP range, 3-6mAs.

• FFD :90-100cm
 projections
• Lateral
• AP Trauma or pathology

• Lateral
When Elbow joint cannot be extended
• AP
• Axial

• Lateral
Proximal radio-ulnar joint
• AP Oblique

• AP
Ulnar groove
• Axial

• AP
• Axial Trauma/pathology to the head of radius
• Lateral with rotation
 Lateral: Position of patient and cassette

• Seat the patient at the end of the radiographic table(with the affected side
nearest to the table)

• Place the humerus and elbow joint in the same plane with elbow flexed 90º to
the tabletop.

• The shoulder is lowered so that it is at the same height as the elbow and wrist,
such that the medial aspect of the entire arm is in contact with the tabletop.

• Center the cassette to the elbow joint and adjust it diagonally to include most
of the arm and forearm.

• Rotate the hand and wrist in to a true lateral position, thumb side up, and
ensure that the humeral epicondyles are perpendicular to the plane of the
cassette.
 Direction and centering of the X-ray beam

• The vertical central ray

is centered over the
lateral epicondyle of the
humerus.
 EVALUATION CRITERIA
• Distal humerus, forearm should be clearly
demonstrated

• Flexed elbow joint

• Superimposed humeral condyles

• Radial head partially superimposing the

coronoid process

• Olecranon process seen in profile

• Bony trabeculation, soft tissue at the anterior

and posterior distal humerus and proximal
forearm should be visible
 AP: Position of Patient and cassette

• With the patient in the lateral position, the patient’s arm is externally rotated.

• Extend the elbow fully, supinate the hand such that the posterior aspect of the
entire limb is in contact with the tabletop and the palm of the hand is facing
upwards.

• The unexposed half of the cassette is positioned under the elbow joint, with its
short axis parallel to the forearm.

• Center the cassette to the elbow joint.

• The arm is adjusted such that the medial and lateral epicondyles are equidistant
from the cassette. To achieve this, ask the patient to lean adjust his trunk until the
humeral epicondyles and anterior surface of the elbow are parallel with the plane
of the cassette.

• The limb is immobilized using sandbags.

 Direction and centering of the X-ray beam

• The vertical central ray

is centered through the
joint space 2.5 cm distal
to the point midway
between the medial
and lateral epicondyles
of the humerus.
 AP: forearm in contact

• Seat the patient near the radiographic table with the affected side
nearest to the table.

• The posterior aspect of the forearm is placed on the table, with the
palm of the hand facing upwards.

• The cassette is placed under the forearm, with its centre under the
elbow joint.

• Ask the patient to adjust the arm or lean until the humeral
epicondyles and anterior surface of the elbow are parallel with the
plane of the cassette.

• Immobilize the limb with sandbags

 Direction and centering of the X-ray beam

• The vertical central ray

is centered in the
midline of the forearm
2.5 cm distal to the
crease of the elbow
 AP – upper arm in contact

• The patient is seated alongside the table, with the affected side
nearest to the table.

• The posterior aspect of the humerus is placed on the table, with

the palm of the hand facing upwards.

• The cassette is placed under the forearm, with its centre under the
elbow joint.

• The arm is adjusted such that the medial and lateral epicondyles
of the humerus are equidistant from the film.

• The limb is supported and immobilized in this position.

 Direction and centering of the X-ray beam

• The vertical central ray

is centered midway
between the
epicondyles of the
humerus
 Evaluation criteria
• The image should
demonstrate the distal
third of humerus and
the proximal third of
the radius and ulna
 Axial – upper arm in contact
• Seated alongside the table, with the affected side nearest to the table the
patients elbow is fully flexed, and the palm of the hand is facing the shoulder.

• The posterior aspect of the upper arm is placed on the cassette, with the arm
parallel to the long axis of the cassette.

• Center the cassette to the elbow joint.

• The arm is adjusted such that the medial and lateral epicondyles are equidistant
from the cassette. To achieve this, ask the patient to lean adjust his trunk until
the humeral epicondyles and anterior surface of the elbow are parallel with the
plane of the cassette.

• The limb is immobilized using sandbags if necessary.

 Direction and centering of the X-ray beam

• For the lower end of the

humerus and the olecranon
process of ulna, the vertical
central ray is centered 5 cm
distal to the olecranon process.

• For the proximal ends of the

radius and ulna, including the
radio-humeral joint, thecentral
ray is directed at right-angles to
the forearm and centred 5 cm
distal to the olecranon process.
 Evaluation criteria
• The image will include the
olecranon process and the
lower third of the radius
and ulna superimposed
on the lower third of the
humerus.

• The exposure should be

adequate to visualize all
three bones.
 Axial – forearm in contact
• Seated alongside the table, with the affected side nearest to the table the
patients elbow is fully flexed, and the palm of the hand is facing upwards.

• The forearm is fully supinated, with the posterior aspect of the forearm
resting on the cassette and the arm parallel to the long axis of the cassette.

• The patient’s trunk is adjusted in order to bring the medial and lateral
epicondyles of the humerus equidistant to the cassette.

• Center the cassette to the elbow joint.

• The limb is immobilized using sandbags if necessary.

 Direction and centering of the X-ray beam

• For the proximal ends of the radius

and ulna and the radio-humeral
joint, the vertical central ray is
directed to a point on the posterior
aspect of the upper arm 5 cm
proximal to the olecranon process.

• For the lower end of the humerus

and the olecranon process of the
ulna, the central ray is directed at
right-angles to the upper arm
centered to a point 5 cm proximal
to the olecranon process.
 Elbow: Lateral head of radius(1)
• For the first projection, the
patient is positioned as for
a lateral elbow projection,
with the palm of the hand
vertical. The forearm is
immobilized using a
sandbag.

• Direct the vertical central

ray is centered to the lateral
epicondyle of the humerus.
 Elbow: Lateral head of radius(2)
• For the second exposure, the
upper arm and elbow are
maintained in the same
position, whilst the hand is
rotated medially until the
palm of the hand rests on the
table. The forearm is
immobilized using a sandbag.

• Direct the vertical central ray

is centered to the lateral
epicondyle of the humerus.
 Elbow: Lateral head of radius(3)

 For the third exposure, the upper

arm and elbow are maintained in
the same position, whilst the
hand is rotated further medially,
until the palm of the hand is
vertical, facing away from the
body. The forearm is immobilized
using a sandbag.

 Direct a vertical central ray is

centered to the lateral
epicondyle of the humerus.
Evaluation criteria
 Proximal radio-ulnar joint – oblique:
positioning of patient and cassette
• The patient is positioned for an anterior projection of the
elbow joint.

• The cassette is positioned under the elbow joint, with the

long axis of the cassette parallel to the forearm.

• The humerus is then rotated laterally (or the patient leans

towards the side under examination) until the line between
the epicondyles is approximately 20 degrees to the cassette.

• The forearm is immobilized using a sandbag.

 Direction and centering of the X-ray beam

• The vertical central ray

is centered 2.5 cm distal
to the midpoint
between the
epicondyles.
 Evaluation criteria

• The image should

demonstrate clearly the
joint space between the
radius and the ulna
 Ulnar groove(axial): positioning of patient
and cassette

• The patient is seated alongside the X-ray table, with the affected
side nearest the table.

• The elbow is fully flexed, and the posterior aspect of the upper
arm is placed in contact with the tabletop.

• The arm is then externally rotated through 45 degrees and

supported in this position.

• The cassette is positioned under the lower end of the humerus,

with its centre midway between the epicondyles of the humerus.
 Direction and centring of the X-ray beam

• The vertical central ray

is centered over the
medial epicondyle of
the humerus.
 Evaluation criteria
• The exposure is chosen
to demonstrate the
ulnar groove in profile

Radiograph of elbow
showing ulnar groove