ANATOMY OF ELBOW

JOINT
SECONDARY CENTERS OF
OSSIFICATION
 There are 6 ossification centers around the elbow joint.
 These ossification centers all appear at different ages
and they all fuse to the adjacent bones at various ages.
 The mnemonic of the order of appearance of the
individual ossification centers is C-R-I-T-O-E: Capitellum,
Radial head, Internal (medial) epicondyle, Trochlea,
Olecranon, External (lateral) epicondyle.
 The ages at which these ossification centers appear are
highly variable, but as a general guide, remember 1-3-5-
7-9-11 years.
 These fuse at 17-18 years of age.
 The capitellum contributes to the growth of
the humerus and is therefore considered an
epiphysis. The other ossifications centres
are called traction epiphyses or apophysis.
ELBOW JOINT
 Synovial hinge joint
 Incorporates humeroulnar, humeroradial
and superior radioulnar joints as one
cavity.
Articular surfaces
 Trochlea-- articulates with ulna
 Capitellum-- articulates with radius
 Head and ulnar notch of radius
 Trochlear fossa and radial notch of ulna
1.RADIAL FOSSA 2.LATERAL EPI 3.CAPITELLUM 4.TROCHLEA 5.MEDIAL
EPI 6.CORONOID FOSSA 7.OLECRANON FOSSA
CAPSULE
 Attached to the margins of articular surfaces of
radius and ulna.
 Capsule is thickened medially and laterally and to
less extent in front and behind.
 These thickened segments are described as distinct
ligaments as follows:

1. Anterior ligament.
2. Posterior ligament.
3. Ulnar collateral ligament.
4. Radial collateral ligament
Left elbow-joint, showing anterior and ulnar collateral

ligaments.
Left elbow-joint, showing posterior and radial collateral ligaments.
 Anterior ligament is a broad and thin fibrous
layer covering the anterior surface of the
joint.
 Posterior ligament thin and membranous, and
consists of transverse and oblique fibers.
 Radial and ulnar collaterals are lateral and
medial thickenings of capsule.
 Annular ligament surrounds head of radius.
RADIOLOGICAL FEATURES
OF ELBOW JOINT
PLAIN RADIOGRAPHS
Elbow radiographs are some of the most
commonly encountered. Standard views are:
 Anterior-posterior projection.
 Lateral projection.
Sometimes oblique views are also obtained.
 Lateral views are obtained with elbow flexed
at 90 degrees. The patient's wrist will be in
the lateral position, and the distal humerus
will have a minimum antero-posterior
dimension.
 a true lateral elbow will demonstrate the distal
humerus at its narrowest.
HOCKEY STICK ANALOGY
FIGURE EIGHT OR HOUR
GLASS SIGN
FAT PADS
 Several fat pads are located between the
fibrous capsule and the synovial membrane.
Fat pads are near the synovial fold between
the radius and ulna and over the olecranon,
coronoid, and radial fossae. These fat pads
are extrasynovial but intracapsular
 In a normal elbow, anterior fat pad is nestled
in the coranoid fossa. The posterior fat pad
occupies the olecranon fossa.
FAT PAD SIGN
 The fat pad sign or sail sign indicates that the
patient has sustained an intra-articular injury.
Importantly, it does not indicate that the patient has
definitely sustained an intra-articular bony injury.
 anterior fat pad sign indicates a probability of intra-
articular fracture of approximately 70-80%, whereas
a posterior fat pad sign indicates a 90% chance of
intra-articular fracture. The anterior fat pad can be
seen in a normal elbow. The posterior fat pad sign is
never visible in a normal elbow.
SUPINATOR FAT PAD SIGN
 The supinator fat pad can be raised or
obliterated as a result of bony injury,
particularly to the radial head. It is one of
those unreliable soft tissue signs, but it is
worth examining as a guide to potential bony
injury, particularly to the radial head.
NORMAL ELBOW ALIGNMENTS
 The normal alignment lines of the elbow can
be a guide both to good positioning and the
existence of subtle pathology.
 The two normal alignment criteria are the
anterior humeral line and the proximal radial
line.
Anterior humeral line
 Line drawn along the anterior cortex of the
distal humerus in the lateral view. This line is
described as passing through the middle third
of the capitellum.
Proximal radial line
 Line drawn through the middle of the radius
that should bisect the capitellum.
MRI ELBOW JOINT
MRI for the evaluation of the elbow is considered medically
necessary for the following indications:
 Fractures in children.
 Evaluation of avascular necrosis in the radial head.
 When neural conduction studies are inconclusive and symptoms
are refractory to conservative therapy.
 Evaluation of suspected avascular necrosis of the capitellum.
 Evaluation of intra-articular loose bodies.
 In the preoperative assessment of heterotopic ossification.
 Evaluation of suspected cartilaginous defects.
CT for the evaluation of the elbow is considered medically
necessary for the following indications:
 Suspect intra-articular osteocartilaginous body.
ULNAR COLLATERAL
LIGAMENT
 Medial elbow joint stability.
 Composed of: anterior bundle, posterior
bundle, transverse bundle.
 On MRI, UCL is hypointense on all
sequences.
Coronal short-tau inversion recovery (STIR) image
demonstrates a normal ulnar collateral ligament.
LATERAL COLLATERAL
LIGAMENT
 4 components:
 Radial collateral ligament—lateral joint
stability
 Lateral ulnar collateral ligament—
posterolateral stability
 Annular and accessory annular ligament—
stability of proximal radioulnar jt.
Coronal STIR image shows a normal radial collateral ligament.
LUCL = lateral ulnar collateral ligament, a part of radial collateral

ligament.
Muscles And Neurovascular Structures
Around The Elbow Joint

4 groups of muscles:
 Posterior
 Anterior
 Medial
 Lateral.
 Posterior group: Triceps and anconeus
 Anterior group: biceps brachii and brachialis
 Lateral group: supinator and brachioradialis
and origin of extensor muscles
 Medial group: pronater teres, palmaris
longus and flexor muscles
ARTERIES AROUND ELBOW
JOINT
 Brachial artery
 1-2 cm distal to elbow joint it divides into
ulnar and radial arteries
NERVES AROUND ELBOW
JOINT
 Median nerve—parallels course of brachial
artery
 Ulnar nerve– posteromedial side of elbow
 Radial nerve—descends between brachialis
and brachioradialis
ARTHOGRAPHY
 Achieved by injecting contrast medium
between radial head and capitellum
 ‘Bugs bunny sign’ – synovial cavity outlined
proximally
DIRECT MR ARTHOGRAPHY
 MR arthography extends the capabilities of
conventional MR imaging
 Either saline solution or diluted gadolinium
may be injected as contrast material.
Direct coronal oblique fat-suppressed T1-weighted MR
arthrographic image anterior band of the UCL as a linear low-
signal-intensity area (arrowhead) as well as the RCL (curved
arrow). The contrast material normally pools around the radial neck

(open arrow).
Normal lateral UCL. Coronal oblique fat-suppressed T1-weighted
MR arthrographic image of the elbow shows the course of the
lateral UCL from the lateral humeral epicondyle to the supinator

crest of the ulna (arrows).

Synovial folds within the elbow joint. Axial fat-suppressed T1-
weighted MR arthrographic image demonstrates synovial folds in

the coronoid and olecranon fossae (arrows).

Torn RCL extensor tendons. Coronal fat-suppressed T2-weighted
MR arthrographic image of the elbow shows disruption of the
humeral attachments of the RCL and common extensor tendon

(arrows).
THANK YOU