MSK RADIOLOGY FOR PHYSIOTHERAPIST

1 Dr. Asmaa A. Alshamy, MD

 ELBOW JOINT

Asmaa A. Alshamy .MD

Lecturer of Radiodiagnosis, faculty of
medicine, Zagazig university
ELBOW JOINT
 Elbow development
*Bone structures at the elbow develop within
multiple cartilagenous ossification centres.
Order of elbow ossification centre development
C - Capitulum (or Capitellum)
R - Radial head
I - Internal epicondyle (or medial epicondyle)
T- Trochlea
O - Olecranon
L - Lateral (or external epicondyle)
Mnemonic = C R I T O L
These centers of ossification become visible from 6 months to
12 years of age and in early adulthood fuse to the humerus,
radius or ulna.
Normal elbow X-ray - 10 year old
The red ring shows the position of
the External or 'Lateral'
epicondyle (L) which has not yet
ossified
All the other centers of
ossification are visible
C = Capitulum
R = Radial head
I = Internal epicondyle
T = Trochlea
O = Olecranon
Normal elbow X-ray- AP - (7 year old)
The first three ossification centres are
visible
C = Capitulum
R = Radial head
I = Internal epicondyle
The Trochlea (T) has not yet ossified
IMPORTANT RULE: Suspect avulsion of
the internal epicondyle if it is absent
and there is ossification at the site of
the trochlea
12 years old boy fall while playing
football
Normal elbow X-ray appearances
On the lateral image there is often a visible triangle of low density lying anterior to the humerus.
This is the anterior fat pad which lies within the elbow joint capsule. This is a normal structure.
Anterior humerus line
A line extending from the anterior edge of the humerus should pass through the capitulum with
at least one third of the capitulum seen anterior to it.
Radiocapitellar line
A line taken through the center of the radius should extend so it passes through the center of
the capitulum.

Normal elbow X-ray - Lateral - (7 year old)

1-Normal anterior fat pad
2-The posterior fat pad is not visible - soft
tissue of the triceps muscle is not separated
from the posterior edge of the humerus
3-More than one third of the capitulum lies
in front of the anterior humerus line
 Elbow joint ( Sail sign)
The elevation of the anterior fat pad to create a
silhouette similar to a sail from a boat. It indicates
the presence of an elbow joint effusion.

Elevation of the anterior fat pad usually heralds the

presence of an occult fracture. In adults, this is
usually a radial head fracture whereas in children,
the commonest cause of a raised elbow fat pad is
a supracondylar fracture
Elbow joint
Elbow joint ( Sail sign)

normal
Elbow X-ray - Radial head fracture
Adult patient
The lateral image shows the anterior fat pad is raised away from the
humerus but does not show a fracture
Posterior fat pad visible - ALWAYS ABNORMAL
A fracture of the radial head is visible on the AP image
 Tendon attachments
Common flexor tendon
Attaches at the medial epicondyle

Common extensor tendon

Originates at the lateral
epicondyle.
 Common Flexor Tendon

The common flexor tendon originates at the medial

epicondyle.
On a T1W-images the tendon should have a low signal
intensity (red arrow).
Elbow joint
Elbow joint
 Common Extensor Tendon
*The common extensor tendon originates at the
lateral epicondyle.
*On T1& T2W-images the tendon should have a
low signal intensity (yellow arrow).
Elbow joint
Left: MRI of a normal elbow - the typical appearance of the extensor tendon (white
arrows) insertion is a black line attaching to the bone
Right: MRI of an elbow with lateral epicondylitis - the tendon has torn off of the bone.
Fluid and scar tissue (white on MRI- white arrows) are interposed between the end of
the tendon and the bone. An abnormal attachment results in pain along the outside
of the elbow with use of the hand and arm.
‫سبحانك اللهم و بحمدك نشهد أن ال اله اال أنت نستغفرك و نتوب اليك‬