Elbow (lateral view)

Dr Aditya Shetty et al.

The lateral elbow view is part of the two view elbow series, examining the distal humerus, proximal radius and ulna. It is deceptively one of the more technically demanding projections in radiography 1-3.

The projection is the orthogonal view of the AP elbow allowing for examination of the ulna-trochlear joint, coronoid process, and the olecranon process. Used to assess both the anterior humeral and the radiocapitellar line.

  • patient is sitting next to the table
  • at 90 degrees elbow flexion, the medial border of the palm and forearm are kept in contact with the tabletop (see figures 1-3)
  • the shoulder, elbow and wrist are kept in the same horizontal plane (see figure 1)
  • rotate the hand so the thumb is pointing towards the ceiling, ensuring all aspects of the arm from the wrist to the humerus are in the same plane
  • lateral projection
  • centring point
    • lateral epicondyle of the humerus
  • collimation
    • superior to distal third of the humerus 
    • inferior to include one-third of the proximal radius and ulna
    • anterior to include the skin margin
    • posterior to skin margin
  • orientation  
    • landscape
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60 kVp
    • 2-5 mAs
  • SID
    • 100 cm
  • grid
    • no
  • medial epicondyle is superimposed over the anterior third of the distal humerus, rather than dead centre
  • there is a superimposed, concentric relationship of the trochlear groove (smallest circle) and the medial lip of the trochlea with the capitellum
  • olecranon process is visible in profile
  • elbow joint is open; radial tuberosity is anterior with slight superimposition of the radial head over the coronoid process

If the capitellum is seen protruding posteriorly on the film, this is a result of external rotation, and this is typically corrected if you lower the hand of the affected side.

On the contrary, external rotation is evident via the capitellum is projecting anteriorly in addition to the medial condyle moving posterior, creating a double concave like protuberance. That is alleviated via placing the side in questions arm on a small foam block, essentially raising the hand to ensure all aspects of the upper limb are in the same plane.

An excellent tool for identifying the capitellar is making use of the radiocapitellar line, the middle of the radial head transects the capitellum unless there is pathology such as a dislocation.

Otherwise, it is worth learning the anatomical and radiological appearances of the capitellum, trochlea and the medial epicondyle to assess the optimal lateral elbow. 


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Article Information

rID: 31133
Section: Radiography
Synonyms or Alternate Spellings:
  • Elbow lateral view x ray
  • Elbow lateral view radiograph

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Cases and Figures

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    Figure 1: elbow lateral positioning
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    Figure 2: elbow lateral positioning
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    Figure 3: elbow lateral positioning
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    Figure 4: right elbow lateral with joint effusion
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