elbow protocol

Question 1

Common Extensor Tendon (CET) - ‘Tennis Elbow’ protocol?

Answer 1

• Flex the elbow
• Put the toe of the probe on the lateral humeral epicondyle with the heel towards to wrist.
• The CET will be a fibrillar echogenic flat topped insertion.

Question 2

Common Extensor Tendon (CET) - ‘Tennis Elbow’ what to look for?

Answer 2

Convexity indicating swelling (should be flat)
Loss of fibrillar architecture
Calcification
Hyperaemia

Question 3

Radial Nerve protocol?

Answer 3

• With the arm supinated
• Place the probe transversely, centered on the lateral aspect of the anterior elbow crease.
• The radial nerve is directly beneath.
• Follow it proximally around the back of the upper arm.
• Then distally into the forearm where it divides into superficial and deep branches.

Question 4

radial nerve what to look for?

Answer 4

• ganglia

- entrapment of the deep branch through the supinator

Question 5

Radial Collateral Ligament (RCL) protocol?

Answer 5

• Is difficult to see (As with the Ulna collateral ligament).
• Is a fan-like band.
• With the elbow flexed
• The RCL is seen as an extension from the annular ligament around the radial head up to the humerus deep to the CET.

Question 6

what to look for with the radial collateral ligament (RCL)?

Answer 6

• absence of the bibrillar architecture

Question 7

ANTERIOR ELBOW patient position?

Answer 7

• have arm supinated and gently flexed

Question 8

anterior elbow joint?

Answer 8

Scan in sagittal across the antecubital fossa to assess for a joint effusion.

Question 9

Biceps Brachii Tendon insertion?

Answer 9

• Begin in transverse and follow distally
• Rotate into longitudinal and follow to the insertion
• You will need pressure on the heel and to angle from the ulna aspect as the tendon dives to insert onto the radial tuberosity.

Question 10

biceps brachii tendon insertion- what to look for?

Answer 10

Continuous integrity of the tendon from the musculo-tendinous junction to the insertion.

Question 11

Common Flexor Tendon (CFT)-‘Golfers Elbow’?

Answer 11

Flex the elbow
Put the toe of the probe on the medial humeral epicondyle with the heel towards to wrist.
The CFT will be a fibrillar echogenic flat topped insertion.

Question 12

Common Flexor Tendon (CFT)-‘Golfers Elbow’- what to look for?

Answer 12

Convexity
Loss of fibrillar architecture
Calcification
Hyperaemia

Question 13

Ulna Collateral Ligament (UCL)?

Answer 13

Is difficult to see (As with the radial collateral ligament)
Is a fan-like band. Usually the posterior aspect is affected.
With the elbow flexed
The UCL is seen posterior and beneath the common flexor tendon

Question 14

UCL- what to look for?

Answer 14

Absence of the fibrillar architecture

Question 15

Ulna Nerve?

Answer 15

With the elbow flexed
Place the probe transversely, across the Olecranon and medial humeral epicondyle
The ulna nerve is directly beneath in the ulna groove
Follow it proximally around the back of the upper arm
Then distally down to the wrist

Question 16

ulna nerve- what to look for?

Answer 16

Ganglia

Subluxation out of the groove during extension

Question 17

Triceps Insertion?

Answer 17

Place the heel of the probe on the tip of the Olecranon tip
Assess in longitudinal and transverse
Check the integrity of the tendon

Question 18

Olecranon Fossa?

Answer 18

In longitudinal the dip in the posterior humerus is deep to the triceps
In transverse the lateral borders of the fossa are visible
Check for loose calcific bodies or fluid

Question 19

Olecranon Bursa?

Answer 19

If particularly rounded and swollen, this can be difficult maintain contact to scan.
You may need a standoff pad or pile of thick gel over the slightly flexed Olecranon tip.
The swollen Olecranon bursa will be seen as a complex fluid collection over the Olecranon tip.
Usually has increased vascularity.