Presentation
Ongoing elbow pain with locking. ?osteochondral lesion. ?plica
Patient Data
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.
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.
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 utilised, 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.