X-ray of the elbow joint

Radiography is a diagnostic procedure with a solid record of more than 120 years. But, despite the development of new modern methods of diagnosing various diseases, it does not lose its relevance to this day. X-ray equipment is available in almost all clinics, the procedure of research is simple in execution, and by informativity is inferior to other methods. If a doctor suspects articular pathology, the X-ray will be the most basic method of diagnosing the problem. One of the most popular diagnostic procedures in traumatology is the x-ray of the elbow joint, the joint of bones, which can be damaged not only because of injuries, but also as a result of some pathological processes occurring in the body.

Indications for the procedure

Radiography is a method of diagnosing internal injuries, which is used in cases when the doctor is difficult to diagnose by external signs, or to clarify certain details of tissue damage. X-rays give the opportunity to see the body through to detect pathological changes in muscles, bones, cartilages, etc., which are hidden from the eyes of a person.

X-ray of the elbow joint, like other methods of examination using rays of the X-ray spectrum (ionizing radiation), is not quite a safe procedure that can cause radiation burns and cell mutation, increase the risk of developing tumors. The true degree of danger of X-rays depends on the duration and frequency of irradiation procedures. It is clear that such a diagnostic method, as an x-ray, can not be used purely out of curiosity. A doctor should have good reasons to direct a person to a survey.

As for the pathology of the elbow joint, such weighty reasons are:

• unexplained pain in this area without external damage,
• swelling of the soft tissues in the elbow area,
• change in color of tissues (red, bluish tint),
• local temperature rise,
• complaints about the limited movements of the arm in the elbow,
• injuries of the elbow, accompanied by pain syndrome, reddening of the tissues and their swelling, both with violation of the integrity of soft tissues, and without visible damage.

With regard to traumatic injuries, the X-ray allows you to exclude or confirm fractures and dislocations that hamper the treatment.

It must be said that X-rays are prescribed not only by traumatologists for suspected fractures of the brachial, ulnar or radial bones, or dislocation of the forearm bones in the elbow area. If there was no trauma, but suspicious changes in the color and structure of the soft tissues are detected, there are pains in the elbow, limiting hand movements, first of all we go to the therapist, and he decides to direct a person to an x-ray, or offer a consultation with an orthopedist. All these doctors can give directions to the x-ray of the elbow joint, if this is required to clarify the diagnosis.

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Preparation

X-ray examination - one of the simplest methods of diagnosis, even if only because it does not require virtually no preparation for the procedure. The only thing that the doctor will ask is to release the hand below the shoulder from clothes, ornaments, watches. No restrictions are required in the diet or medication.

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Technique of the x-ray of the elbow joint

X-rays of the elbow joint are usually held in the sitting position, but if necessary, the diagnosis can also be made in the supine position (for example, if the person is unconscious) or standing up. The patient sits on a chair, propped up to a special table of the X-ray apparatus, sideways to it. The examined limb is placed on a table in a position that the doctor will indicate. The edge of the table should be slightly above the level of the armpits.

In order to make the picture clear, the limb must remain stationary during the study. If it is difficult for a patient to hold a fixed position of the hand, the limb is fixed on both sides with special pouches filled with sand or other heavy material.

According to the standards, the radiography of the joint should be performed in 2 projections. Research in direct projection requires the most to unbend the hand and put it on the table so that the palm looks up. The arm at the elbow should be slightly elevated.

For lateral projection, the arm at the elbow bends at a right angle and is laid with the back side of the brush upward. The patient should sit at such a height that the shoulder and forearm are on the same level.

In some cases, a study is needed in another projection - axial, when the rear of the humerus and the elbow are clearly visible. To carry out the research, the arm should be fully bent at the elbow, as far as possible. On the table, the hand is located with an emphasis on the humerus.

In all cases, the X-ray cassette is located under the elbow. To protect the breasts and the body, patients are asked to wear a special apron made of a material that does not transmit X-rays.

Depending on the equipment used (film or digital), the result of the study can be obtained on a special film that requires a preliminary manifestation in a specially equipped room, or on a digital medium from which you can print a picture on paper or view it on a computer monitor.

Digital radiography, which appeared much later than film, is becoming increasingly popular, because it allows you to magnify the picture on the monitor, to zoom in on individual elements to see the damage. And you can store a picture on a disk for a long time without distortion. Perhaps in the future it will still be needed for comparison if new traumas are received, or to evaluate the effectiveness of treatment. Such pictures can be archived and stored for a long time on the computer of a specialist doctor.

Contraindications to the procedure

X-rays of the elbow joint, like any X-ray study, is not considered a safe procedure due to certain properties of ionizing radiation. And, despite the fact that it is done, if necessary, even for children, the procedure still has some limitations.

The main limitation is the children's age. In theory, X-rays are allowed to make children over 14 years old. This is not about possible pathologies, because usually the dose of radiation and the duration of the procedure are adjusted so that they can not cause significant harm. Just the effect of ionizing radiation on the children's body is more pronounced and can affect the development of various systems of the child. And the younger the child, the more dangerous it is to X-ray. For example, infants in the formative stage are many important body systems, so cell mutations leading to disruption of their activity are more likely.

If necessary, X-rays are made even for newborns, but with this special protective equipment cover all parts of the child's body except for the area under investigation. Older children should always cover the chest, stomach and pelvic area with a protective apron. Protect from ionizing radiation also needs the thyroid and eye areas.

If the X-ray radiation is so dangerous for young children, one can imagine what harm it can do to an unborn baby with unformed vital systems. Irradiation of a pregnant woman is fraught with the birth of a child with various mutations and pathologies, therefore, future X-rays are contraindicated for future moms.

X-rays to a pregnant woman can be done only on strict indications, while the abdomen area should be protected by a lead apron, not allowing X-rays. Ideally, a protective apron should be used in all cases of radiography in order to reduce the negative impact of radioactive radiation on the human body.

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Normal performance

The elbow joint is a rather complicated structure, including the mediastinal, pleural and proximal radiophilic joints. To carefully consider all these components and their components, radiography is carried out not in one but in 2-3 projections. Accordingly, the interpretation of the results goes along all three components of the elbow joint, and not common words.

If the X-ray of the elbow joint is normal, the survey report will note that its general x-ray anatomical orientation does not differ from the usual one, and all ratios of bone and joint sizes are standard. The components that make up the joint are commensurate with each other, their size and shape are common. In the picture, in a direct projection, 3 articular slits corresponding to the 3 joints, united by the common name " elbow joint ", are clearly visible and distinguishable :

• the humerus joint (the joint of the humerus block and the coronoid process of the ulna) - a blocklike simple joint,
• the humerus joint (the junction of the elevated part of the head of the humerus and the cavity of the head of the radius) - a spherical simple joint,
• the proximal (upper) radiophilic joint (the junction of the radius of the radial bone and the radial cavity of the ulna) is a cylindrical simple joint.

The width of the joint cracks in the block and globose joints should be the same and have a standard size.

In the anatomy of the human bone system there are such concepts as epiphysis, diaphysis and metaphysis of bone. An epiphysis of a bone is called an enlarged rounded end of a tubular bone (its head, including convex and concave parts), which forms the joint. The articular part of the epiphysis is covered by cartilage.

Diaphysis is nothing but the central part of the tubular bone (its body). Between the epiphysis and the diaphysis there is a metaphysis (in the childhood and adolescence it is responsible for growth), adjacent to the cartilaginous epiphyseal plate, which in turn is articulated with a subchondral plate with many capillaries and nerve endings.

On the roentgenogram of the normal elbow joint, the cartilaginous tissue of the epiphyses of bones (also called the endoplastic plate of the epiphysis or the cartilaginous growth plate) should have an even and clear contour. The subchondral part of the epiphysis should have a porous (spongy) structure inherent in it.

Visible areas of the metaphysis should have a normal shape without thickening, the structure of bone tissue should correspond to the age of the patient (ossification of the metaphysis occurs as a person grows up and ends at 18-25).

Visible parts of the diaphysis of bones should also have the usual shape and structure without cracks, dislocations, thickenings, bends.

The elbow joint also has some soft tissue parts. These include the articular bag (articular capsule) and intraarticular ligament. The X-ray of the normal joint does not reveal ossification in these parts (bone tissue on a black and white X-ray has a lighter shade). Soft tissues surrounding the joint should have an appropriate volume (array), structure and shape, which indicates the absence of tumors and dystrophic changes.

But meanwhile you spoke about normal parameters of an X-ray of an elbow joint. Now let's try to understand what the doctor sees when he is approached by a patient with one of the most popular abnormalities of the elbow, because in most cases the result will not be as cloudless as we saw it above. In the end, not healthy people turn to medics for help.

For example, a person seeks a doctor with complaints of severe spontaneous pain in the elbow, which is strengthened by movement of the hand and physical activity. This muscle strength is weakening. Such symptoms may indicate the ulnar epicondylitis - a disease of inflammatory-degenerative elbow tissue that affects the bones, periosteum, tendons, and is the result of a constant overload of the elbow joint.

Symptoms of epicondylitis, often affecting people of certain specialties, are similar to other pathologies (arthritis, bursitis, soft tissue injuries, fractures of the elastoid process of the ulna or radius, fracture of the epicondyle, tunnel syndrome, etc.). Differentiate one disease from another helps differential diagnosis. True, it rarely relies not on the results of the radiograph. At the beginning of the disease, the X-ray can only eliminate joints and bone fractures, but it is impossible to diagnose the epicondylitis itself with its help.

But when the disease acquires a chronic course characterized by degenerative changes in the tissues of the joint, an X-ray image will help not only diagnose the disease, but also assess the degree of joint damage in order to determine the methods of treating the pathology.

X-ray signs of chronic epicondylitis of the elbow joint  are the centers of osteoporosis (destruction of the cat's tissue), bone growths (osteophytes), formed as a result of prolonged inflammation, densities on the ends of the tendons and in porous bone structures. Since the bone structures are worse than X-rays, than soft tissues, there will be more than light spots in the picture, and in places of osteoporosis, the color, on the contrary, will be closer to gray.

For example, with no less popular pathology, called arthrosis of the elbow joint, the first thing to be noted on the roentgenogram is a narrowing of the joint cracks, which makes it difficult for the arm to move and flexing it at the elbow. This can be seen from a too thin strip (until its absence) at the site of the joint space. The contours of the cartilaginous tissue in the region of the joints will also be changed.

As for another fairly popular pathology, such as an elbow dislocation, which happens in both adults and children, then often roentgenography is not required. Symptoms of the dislocation are fairly clear: severe pain to the elbow joint, restriction of its mobility due to a strong increase in the intensity of the pain syndrome, swelling of soft tissues in the lesion, a strong decrease in the sensitivity of the hand. In addition, the doctor can not feel the pulse on the arm below the elbow, but it is usually good to feel the bulging end of the radius.

Depending on the conditions under which the dislocation was obtained (if you fall on an elbow bent or bent at the elbow), you can diagnose the posterior, lateral (forearm bones in the joint are biased backward and inward or outward) or a more rare anterior dislocation.

Basic x-ray signs of dislocation of the elbow joint:

• Absence of abutment of articular surfaces of bones with violation of their location relative to each other. In the joints, the hollow of one bone is filled with the convexity of the head of the other, with the dislocation of the cavity being empty. Depending on how much the bones are displaced relative to each other, a full or partial dislocation of the elbow is diagnosed. In the latter case, a part of the head of one bone touches the hollow of the other bone.
• Displacement of the axis of the dislocated bone. This sign is very important when the X-ray of the elbow joint is performed in children, because the distal parts of the bones in the child are still in the process of ossification, so it is very difficult to assess the changes in the size of the gap between the bones (cartilage passes X-rays almost as well as soft tissue, therefore on the roentgenogram they are practically not visible, and the joint gap should be understood as the distance between the stunted areas). True, with a lateral fracture, the degree of bone bias is very difficult to estimate, so you have to take pictures in different projections.

In a third of cases of traumatic dislocations of the elbow joint, there is a detachment of small parts of the bone at the place where the joint capsule and ligaments are attached to them. Small fragments usually do not pose a danger and do not interfere with correcting the dislocation. But if it is, for example, the separation of the medial epicondyle, which sometimes happens with an external dislocation of the elbow, sometimes you have to resort to surgery to remove the exfoliated piece of bone (not allowing you to place the dislocated bone in place.) On the x-ray, the fragment is seen as an abnormal clarification in shape and size corresponding to the formed notch on the damaged bone.

When the picture shows an old dislocation that was not corrected at the time, the picture may be as follows: osteoporosis or destruction of distal parts of displaced bones with changes in their shape and size, atrophy of soft and hard tissues in the joint region, the formation of a new articular cavity (neoarthrosis) . The presence of such signs and their severity depends on the "age" of the dislocation. After a freshly dislocated dislocation, changes in the tissues of the joint are not observed, except that we are talking about the detachment of a piece of bone.

X-ray also helps to identify pathological dislocations, which need not be preceded by trauma. A person may not even suspect such damage as a result of strong muscle tension or harmless injury. The cause of pathological dislocations are inflammatory processes in the joint region with a constant accumulation of liquid contents. This leads to a stretching of the joint capsule and the bone in the joint can be displaced even with little mechanical action.

Other causes of pathological dislocations are osteoarthrosis, tumors at the articular ends of bones, congenital defects in the structure of bones, etc. But whatever the reason for the pathological dislocation, a person comes with pain and restriction of the movements of the hand and does not associate them with a dislocation. A clear picture of the pathology can be given by X-ray diagnostics. It will also allow differentiating the dislocation of the bone from a fracture or nadkola, the symptoms of which are outwardly similar.

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Complications after the procedure

Let's just say that the greatest danger to x-rays is in childhood, so it is prescribed in the extreme case, when there is no possibility to resort to safer diagnostic methods: ultrasound (ultrasound) or magnetic resonance imaging (MRI). Computer tomography (CT) in this regard is not so safe and can have effects similar to X-ray irradiation in radiography (the same frequencies are used).

What is so dangerous about X-rays? Its radioactivity and ability to change the properties of cells, as a result of which the functionality of the organs is violated and active proliferative processes in them take place, leading ultimately to the development of tumor processes. Such a situation on a large scale we had the opportunity to observe after the explosion at the Chernobyl nuclear power plant, the consequences of which are being witnessed by its witnesses to this day.

But with the X-ray examination, the situation is somewhat different. We are talking about completely different doses of radiation. The dose of X-ray radiation does not differ much from the radiation dose that we receive when flying on airplanes or passing an introscope at an airport, so it is pointless to talk about possible complications. Many men, women and children use aeroflot services several times a year, and this does not affect their health in any way. Yes, there to say, some people live in areas with an unsuccessful radiation situation, where radiation doses approach X-ray radiation.

It should be noted immediately that not only the dose of radiation, but also the duration of exposure to rays during radiography are strictly limited, therefore 1-3 pictures per year, and the x-ray of the elbow joint is unlikely to be done more often, can not cause significant damage to the patient's body, but will help identify the dangerous pathology and evaluate the effectiveness of the treatment. Even a child without consequences can do about 5-6 pictures a year.

But again you need to take into account the radiation background of the area where the person lives, and the frequency of using services that involve exposure to the body. It is desirable that the total dose of radiation received by a person during the year from various sources does not exceed 3-4 millisieverts.

Reviews

X-ray of the elbow joint is a sufficiently informative non-invasive procedure that can be carried out practically in any clinic, because it does not require the purchase of expensive modern equipment (although modern X-ray machines are considered safer in terms of radiation).

With the help of an X-ray, degenerative-dystophic processes in tissues deep inside the body can be considered to penetrate deep into the bone tissue in order to evaluate its structure and possible changes, to reveal fractures of various parts of the bone and congenital anomalies predisposing to injuries at the slightest mechanical effect. And all this is a doctor can see without surgery, because soft tissues remain transparent for X-rays.

Another advantage of such a survey can be considered the absence of any special preparation for the procedure. A person does not need to limit himself in food, liquids, medicines, prepare skin, etc. And there is no specialized care after the procedure. After taking a quarter of an hour of the results of the examination, the person goes to the treating doctor, who appoints the appropriate treatment.

If, however, a person is afraid of the received dose of ionized radiation, then at home he can drink a glass of other home-made milk, which helps to remove radiation from the body. The same is recommended for people who live or work in regions with an increased radioactive background, but milk should not be local, but delivered from ecologically clean areas.

The damage from X-rays, according to doctors, is significantly less than its usefulness. After all, even the direction of nonspecific dislocations should occur under his control. Not to mention the possibility of revealing hidden pathologies that a person could not even suspect for a long time.

Elbow injuries and degenerative changes in his joints are considered quite common pathologies, and the X-ray of the elbow joint is considered a rather popular procedure. Yes, there are now safer methods for diagnosing bone pathologies, however, X-ray remains one of the most widely used and very inexpensive methods available to almost everyone.