European Society of
MusculoSkeletal Radiology
Musculoskeletal Ultrasound
Technical Guidelines
II. Elbow
Ian Beggs, UK
Stefano Bianchi, Switzerland
Angel Bueno, Spain
Michel Cohen, France
Michel Court-Payen, Denmark
Andrew Grainger, UK
Franz Kainberger, Austria
Andrea Klauser, Austria
Carlo Martinoli, Italy
Eugene McNally, UK
Philip J. O’Connor, UK
Philippe Peetrons, Belgium
Monique Reijnierse, The Netherlands
Philipp Remplik, Germany
Enzo Silvestri, Italy
The systematic scanning technique described below is only theoretical, considering the
fact that the examination of the elbow is, for the most, focused to one quadrant only of the
joint based on clinical findings.
Note
1
For examination of the anterior elbow, the patient
is seated facing the examiner with the elbow in an
extension position over the table. The patient is
asked to extend the elbow and supinate the fore-
arm. A slight bending of the patient’s body toward
the examined side makes full supination and as-
sessment of the anterior compartment easier. Full
elbow extension can be obtained by placing a
pillow under the joint.
1
Elbow
Transverse US images are first obtained by
sweeping the probe from approximately 5cm
above to 5cm below the trochlea-ulna joint,
perpendicular to the humeral shaft. Cranial US
images of the supracondylar region reveal the
superficial biceps and the deep brachialis mu-
scles. Alongside and medial to these muscles,
follow the brachial artery and the median nerve:
the nerve lies medially to the artery.
*
*
Legend: a, brachial artery; arrow, median nerve; arrowheads,
distal biceps tendon; asterisks, articular cartilage of the
humeral trochlea; Br, brachialis muscle; Pr, pronator muscle
2
The distal biceps tendon is examined while keeping the
patient’s forearm in maximal supination to bring the
tendon insertion on the radial tuberosity into view. Be-
cause of an oblique course from surface to depth, por-
tions of this tendon may appear artifactually hypoechoic
if the probe is not maintained pa