Methods of ultrasound of the elbow joint

Structures that are subject to ultrasound evaluation in the elbow joint: the joint cavity itself, articular cartilage, articular capsule; tendons of muscles involved in the processes of flexion and extension of the joint; medial and lateral epicondyle, ulnar nerve. Ultrasonography (ultrasound) of the elbow joint is performed from four standard approaches: anterior, medial, lateral and posterior. Two options of the patient are used for the elbow joint examination: sitting or lying down.

Front access. To examine the area of the coronary fossa of the anterior approach, the arm is slightly bent at the joint. To avoid possible partial ruptures and strains of the tendon, it is necessary to compare with the data with the full extension of the elbow joint. From the anterior-medial approach, the distal part of the biceps tendon of the shoulder, the tendons of the brachial muscle, and the vessels of the coronary fossa are evaluated. To the coronoid process of the ulna, the fibers of the most deeply embedded brachial muscle are attached; they are followed by fibers attached to the tuberosity of the radius of the biceps arm muscle. The shoulder-ray muscle covers the entire length of the forearm: from the humerus above the supracondylar zone to the radial bone in the region of the wrist. In transverse scanning at the level of the coronary cavity, the shoulder-ray, biceps, humerus and round pronator are visualized as hypoechoic muscular structures around the humerus. With longitudinal scanning, these muscles are thrown through the elbow joint.

To assess the tendon-muscle transition, as well as the area of the tendon-bone attachment, it is recommended to use the panoramic scan mode. The median nerve passes between the round pronator and the brachial muscle. The radial nerve lies between the biceps muscle of the shoulder and the brachial muscle.

Medial access. For medial access, the hand should be diverted to the side. From the medial access, the medial epicondyle, the flexor tendon, the joint bag are examined. The sensor is mounted on the medial epicondyle - the direction of scanning of the sensor coincides with the course of the fibers of the tendon. This region is also investigated in the transverse plane. To the medial epicondyle muscle tendons of the flexor muscles are attached.

Lateral access. For lateral access, the arm is shown. From this access, the lateral epicondyle, the extensor tendons, the articular bag are evaluated. The sensor is installed by analogy with the study of the elbow joint from the medial access to the lateral epicondyle of the humerus. The tendons of the extensor muscles of the forearm are examined, which attach to the lateral epicondyle.

Rear access. For examination of the posterior part, the dorsal part of the wrist touches the wing of the ilium. From this position, the elbow process, the tendon of the triceps muscle, the bag of the elbow process are evaluated. To the proximal part of the elbow process is attached the tendon of the triceps muscle, which forms the bag at the attachment site. For examination of the medial part of the posterior surface of the ulnar region, the forearm is withdrawn laterally and rotated outwards. Between the medial epicondyle on the posterior surface and the ulnar process in the depression passes the ulnar nerve. On the forearm, the nerve lies deeper than the elbow flexor of the fingers before entering the Guyon canal, projecting on the surface of the skin along the edge of the hypotenar. On the forearm, the ulnar nerve follows the line connecting the medial epicondyle and the lateral aspect of the pea or hypotenar.

[1], [2], [3]