The document describes the anatomy and radiographic evaluation of the elbow joint. It discusses the bones that make up the elbow, including the distal humerus, radius and ulna. Common x-ray views of the elbow are described along with normal anatomy, landmarks and measurements. Various fractures, dislocations and other pathologies involving the elbow are illustrated along with their radiographic appearance. Specialized projections useful for evaluating specific elbow injuries are also outlined.

1. X-RAY OF ELBOW JOINT
DR. ATHUL D

2. ANATOMY OF ELBOW
JOINT
- HINGE JOINT
- 3 BONES INVOLVED

3. DISTAL HUMERUS
humeral condyle is its expanded distal
end.
Trochlear articulates with the ulna.
Capitulum articulate with head of radius.
Lateral epicondyle
Medial epicondyle

5. OSSIFICATION AROUND ELBOW-
CRITOE
Capitulum – 1 years
Radial head – 3 years
Internal epicondyle – 5 years
Trochlea – 7 years
Olecranon- 9 years
External epicondyle – 11 years

6. X-RAY ELBOW AP VIEW
Part Position: Arm fully
extended, and the hand
supinated.
CR: To the elbow, between and
1 inch below the level of the
epicondyles.
Collimation: To the arm.
kVp: 55 (50 to 60).

7. CLINICORADIOLOGIC
CORRELATIONS:
Alignment - Carrying
angle The axial
relationships of the
humerus to the ulna
should be assessed

8. X-RAY ANATOMY IN AP VIEW
1. Shaft of the humerus.
2. Olecranon fossa, ulna.
3. Medial epicondyle,
humerus.
4. Lateral epicondyle,
humerus.
5. Capitellum, humerus.
6. Trochlea, humerus.
7. Supracondylar ridge,
humerus.
8. Radial head.
9. Neck of the radius.
10. Radial tuberosity.
11. Shaft of the radius.
12. Coronoid process, ulna.
13. Ulna.

9. RADIO CAPITULAR LINE
This line is drawn
through the middle of
the radius and should
bisect the capitulum on
both the lateral and the
AP elbow radiograph.

10. SPECIALIZED PROJECTIONS:
1. Forearm views: With the palm supinated and the wrist
and elbow extended, an AP view is obtained to include
the elbow and wrist.
2. Humerus views: for the full length of the humerus.
-AP view the arm is slightly abducted & forearm
supinated.
- lateral view the elbow is flexed, the arm slightly

11. X RAY ELBOW LATERAL VIEW
Part Position: Elbow flexed to 90, with the ulnar
surface of the forearm flat. The hand in true lateral
position.
CR: Mid-elbow joint, just anterior to the lateral
epicondyle.
Collimation: To the arm, 10 inches along the forearm
axis and 6 inches top to bottom
kVp: 55 (50 to 60).

12. LATERAL VIEW ANATOMY
1. Shaft of the humerus.
2. Capitellum and trochlea.
(superimposed)
3. Olecranon process, ulna
4. Coronoid process, ulna
5. Radial head.
6. Neck of the radius.
7. Radial tuberosity.
8. Coronoid fossa, humerus.
9. Olecranon fossa,
humerus.
10. Supinator fat line (arrow)

13. True lateral view must
show hourglass or
figure of eight
Distal humerus hockey
stick appearance

14. LATERAL VIEW
The yellow line represents
the anterior humeral line
and the red line represents
the proximal radial line.
The important observation
regarding these lines is
that they should intersect
the middle third of the
capitellum on the lateral
view

15. CLINICORADIOLOGIC
CORRELATIONS:
Lateral view is very useful for elbow for fracture & to
demonstrate joint effusion
Alignment: The plane of the radius passes through the middle
of the capitellum (radiocapitellar line).
Soft tissue: Anterior and posterior to the distal humeral
surfaces are pericapsular fat layers interposed between the joint
synovium and fibrous joint capsule (fatpads).

16. SPECIALIZED PROJECTIONS
Radial head capitellum view:
 magnified view of the radial head, which is projected clear of the ulna and
humerus
 for joint effusion and fractures of the radial head, coronoid process, and
capitulum
elbow flexed to 90° in the true lateral
position
the tube is angled 45° toward the radial head

17. Radial head views: Multiple views in various degrees of rotation can
be used to profile the entire circumference of the radial head.
In the lateral position the forearm is slightly supinated
in true lateral
with palm down
Extreme internal rotation with the thumb down.

18. ELBOW: MEDIAL OBLIQUE
PROJECTION
Part Position: Arm fully extended and
the forearm pronated.
CR: 1 inch below the epicondyles.
Collimation: To the arm
kVp: 55 (50 to 60).

19. USES
Close scrutiny of the ulnar-placed structures
including the
 medial supracondylar ridge,
medial epicondyle
 olecranon
Trochlea
coronoid process

20. MEDIAL OBLIQUE ANATOMY
1. Shaft of the humerus.
2. Olecranon fossa, humerus.
3. Medial epicondyle,
humerus.
4. Lateral epicondyle,
humerus.
5. Supracondylar ridge.
6. Olecranon process, ulna.
7. Coronoid process, ulna.
8. Radial head.

21. SPECIALIZED PROJECTIONS:
1. Lateral oblique view:
extended elbow is rotated externally by 45°,
. The view optimizes visualization of the radially sited
structures,
lateral supracondylar ridge
lateral epicondyle,
radiohumeral joint
 lateral margin of theradial head.

22. TANGENTIAL (JONES)
PROJECTION
Demonstrates: Olecranon, ulnar
groove, trochlea, and radial head.
Patient Position: Elbow is fully flexed
and the humerus is placed parallel
to the film.
CR: 2 inches above the olecranon
kVp: 55 (50 to 60).

23. CLINICORADIOLOGIC
CORRELATIONS:
Visualization of the olecranon–trochlear joint
compartment is useful
for detecting intra-articular loose bodies and
degenerative osteophytes.
The ulnar groove, in which lies the ulnar nerve, is also
well seen.

24. NORMAL ANATOMY
1. Olecranon
process.
2. Trochlea.
3. Head of the radius.
4. Neck of the radius.
5. Tuberosity, radius.
6. Medial epicondyle,
7. Olecranon fossa.
8. Ulnar groove.

25. SPECIALIZED PROJECTIONS:
1. Superior-to-inferior view: elbow flexed to
about 110° the forearm is placed on the cassette
in a supine position with the beam passing
through the distal humerus to the proximal
forearm.
used in supracondylar fractures, both before
and after reduction, to assess axial position.
Fractures of the epicondyles and subtle tendon
calcifications

26. CUBITAL TUNNEL VIEW:
From the tangential position, with the elbow fully
flexed, the forearm is externally rotated 15° to show
the cubital tunnel
Medial trochlear lip osteophytes and osteoarthritis of
the medial trochlea– olecranon joint, clearly shown

27. SUPRA CONDYLAR FRACTURES
anterior fat pad sign (sail sign)
posterior fat pad sign
anterior humeral line should
intersect the middle third of the
capitellum in most children
Classification of supracondylar
fractures
type I: undisplaced
type II: displaced with intact
posterior cortex
type III: complete displacement

28. AP AND LATERAL VIEW –
SUPRACONDYLAR FRACTURE95% are extension type
5 % belong to flexion type
In adults invariably needs
surgery

29. MEDIAL EPICONDYLE FRACTURE
avulsion fracture of the
medial epicondyle has
occurred (arrow).
: A similar injury in child or
adolescent has been called
Little Leaguer’s elbow and
is usually associated with
sports requiring strong
throwing motions.

30. INTERCONDYLAR FRACTURE
T or Y shaped
50% of distal humerus fracture in adults

31. OLECRANON FRACTURE
Note the two fracture
lines through the
olecranon process.
The proximal
fragment has
retracted
owing to the pull of
the triceps muscle

32. CORONOID PROCESS
FRACTURE.
LATERAL ELBOW X-RAY
Observe the clearly visible
fracture line through the
tip of the coronoid process
(arrow).

33. FAT PAD SIGN
Lateral, Elbow, Positive Fat-
Pad Sign. The anterior and
posterior fat-pads are
elevated away from the
humeral surface as a result
of joint effusion or
hemarthrosis (arrows)
associated with a subtle
impaction fracture of the
radial neck, evidenced only

34. FRACTURE RADIAL HEAD
A linear fracture
line is visible
extending from the
articular
surface distally
(arrow)

35. CHISEL FRACTURE: RADIAL HEAD.
AP ELBOW X-RAY
Note the vertical fracture
line extending through
the articular
surface of the radial head,
with minimal offset of the
articular contour (arrow).

36. OCCULT RADIAL HEAD FRACTURE.
AP ELBOW X-RAY
A- there is no
evidence of fracture
in the radial head.
B. 2-Month Follow-
Up, AP Elbow. Note
that a vertical
fracture line is now
apparent (chisel
fracture) (arrow).

37. RADIAL HEAD FRACTURE: DOUBLE
CORTICAL
SIGN.increased density of the articular
cortex
of the radial head, with
projection of the opacity below
the articular surface (arrow).
Posteriorly, a fracture line is
identified as a linear radiolucencyIt is the result of an impaction
fracture from the capitellum into
the radial head, which displaces
the cortex distally.
this is the only sign of a radial
head fracture

38. FRACTURE RADIAL HEAD-
MASON CLASSIFICATION
1.
Undisplaced

39. TYPE II – DISPLACED FRACTURE

40. TYPE III - COMMUNITED

41. RADIAL NECK FRACTURE
the thin fracture line
disrupting the lateral
aspect of the radial
cortex
(arrow).

42. #CAPITELLUM-HALFMOON
APPEARANCE

43. OLECRANON FRACTURE
TYPE I-1A Extra articular oblique
1B-Intra articular transverse
TYPEII MIDDLE –INTRA ARTICULAR
2A Single# line
2B-2 #line
[transverse,oblique]
TYPEIII- OLECRANON FOSSA

44. PANNERS
Osteochondritis Dissecans of the Capitellum
Valgus strain of the elbow in throwing sports
such as baseball and football has been
implicated as one causative factor.
Apparently during the throwing motion, the
capitulum is subjected to compression and to
shear forces.

46. ESSEX-LOPRESTI FRACTURE

48. ELBOW DISLOCATION
Posterior & posterolateral
comprise 85% of
dislocations.
50% associated with
fractures if medial
epicondyle, radial head or
neck

49. MONTEGGIA’S FRACTURE
MONTEGGIA’S FRACTURE OF THE
FOREARM.
A fracture through the
proximal one-third of the
ulna is
present, with associated
anterior angulation of the
proximal
fracture fragment. The
radial head has also been
displaced
anteriorly, with
dislocation at the elbow

50. GIANT CELL TUMOR IN RADIAL
HEAD
Within the radial head and
extending into the radial neck
is a loss of bone density, bone
expansion, and thinning of
the cortex caused by a slowly
growing tumor

51. OSTEOCHONDROMA. LATERAL
ELBOW
the large,
cauliflower
exostosis arising
from the radial
tuberosity. Observe
the flocculent
calcification
scattered
throughout this

52. PAGET’S DISEASE: EXPANSILE
MANIFESTATIONS.
AP Elbow. Observe the
expansion
of the proximal radius,
affecting its subarticular
surface.

53. NON-TRAUMATIC MYOSITIS
OSSIFICANS CIRCUMSCRIPTA AT
ELBOW JOINT

54. Thank you