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Normal elbow arthrograms

Case contributed by Dr Dai Roberts

Presentation

Ongoing elbow pain with locking. ?osteochondral lesion. ?plica

Patient Data

Age: 45 years
Gender: Female
Fluoroscopy

Trans-tricep approach

Fluoroscopic-guided trans-triceps tendon arthrogram injection.  

A 25G 40mm needle is inserted through the central triceps tendon and targets the olecranon fossa. Iodinated contrast confirms an intra-articular position.

Fluoroscopy

Trans-tricep approach

The arthrogram injectate is given under fluoroscopic guidance as shown in stack of images, with the arthrogram solution extending into and distending the anterior elbow joint. A total volume of 3mL of arthrogram injectate was given.

MRI

MRI arthrogram

Normal right elbow MRA.  

The articular cartilage is intact and there is no evidence of a plica.  

Case Discussion

The olecranon fossa is an excellent target for image-guided intra-articular intervention. With US-guided intervention, the needle can be guided adjacent to the triceps tendon into the fossa. This is more difficult with fluoroscopic-guided intervention and a trans-triceps approach can be utilized, as demonstrated. 

An alternative method of intra-articular elbow access is via the radiocapitellar joint but caution should be used, as this involves passing through the smaller radial collateral ligament and extravasation of the arthrogram injectate can mask pathology.

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Case information

rID: 75550
Published: 1st Apr 2020
Last edited: 29th Jul 2020
Inclusion in quiz mode: Included
Institution: St. Paul's Hospital

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