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The elbow joint

image of The elbow joint
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Abstract

The following are some of the indications for radiography of the elbow joint: pain on manipulation of the joint; joint instability; swelling or deformity of the joint; atrophy of the adjacent muscles; evaluation of inherited or developmental conditions; ED certification; ED surgery; and abnormal associated long bone growth. This chapter considers radiography; normal anatomy; alternative imaging techniques and abnormal image findings.

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/content/chapter/10.22233/9781910443293.chap13

Figures

Image of 13.1
13.1 Positioning for the ML extended view of the elbow.
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13.2 (a) ML extended view of the elbow of a 5-year-old Dobermann. (b) Diagrammatic representation of the structures seen in (a). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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13.3 ML view of the elbow of an 8-week-old Rottweiler. Note the lack of separate ossification centres for the olecranon and medial epicondyle, which will still develop at the positions indicated (*).
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13.4 ML extended view of the elbow of an adult cat.
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13.5 Positioning for the CrCd view of the elbow.
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13.6 (a) CrCd view of the elbow of a 2-year-old Rhodesian Ridgeback. (b) Diagrammatic representation of the structures seen in (a). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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13.7 CrCd view of the elbow of a 7-month-old Basset Hound. There is also an incomplete fracture of the proximal ulna (arrowed).
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13.8 CrCd view of the elbow of an adult cat.
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13.9 Positioning for the ML flexed view of the elbow.
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13.10 ML flexed view of the elbow of a 2-year-old Rhodesian Ridgeback.
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13.11 ML flexed view of the elbow of a 7-month-old Basset Hound. There is also an incomplete fracture of the proximal ulna just caudal to the radial head (arrowed).
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13.12 Cd75°M-CrLO view of the elbow of a 2-year-old Rhodesian Ridgeback.
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13.13 Cr15°L-CdMO view of the elbow of a 2-year-old Rhodesian Ridgeback.
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13.14 Cr15°L-CdMO view of the elbow of a cat. Note the normal supracondylar foramen on the distomedial aspect of the humerus.
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13.15 Cr15°L-CdMO view of the elbow of a 2-month-old Rottweiler. Note the incompletely fused humeral condyles.
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13.16 Cr45°M-CdLO view of the elbow of a 2-year-old Rhodesian Ridgeback. Note the prominent olecranon tubercles (arrowed).
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13.17 Di35°M-PrLO view of the elbow of a Rhodesian Ridgeback. The arrow indicates the medial coronoid process.
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13.18 CrCd view of the elbow of an adult Irish Wolfhound showing the supinator longus muscle sesamoid on the proximolateral aspect of the radius (arrowed) and a FMCP on the medial aspect of the joint.
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13.19 (a) ML extended view of the elbow in a 9-year-old cat showing a 1 mm-wide supinator longus muscle sesamoid just dorsoproximal to the radial head (arrowed). (b) Cr45°M-CdLO view of the elbow of the same cat showing the supinator longus muscle sesamoid dorsolateral to the radial head (arrowed).
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13.20 (a) CrCd view of the elbow of a 3.5-month-old Yorkshire Terrier that fell off a bed and suffered a lateral condylar fracture. (b) ML view of the elbow of the same dog. Note the caudally displaced lateral condyle superimposed on the cranial ulna.
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13.21 (a) CrCd view of the elbow of a 4-month-old Boerboel that was hit by a car. There is a lateral condylar fracture (Salter–Harris type IV) combined with a Salter–Harris type III fracture, which has also displaced the medial condyle. (b) ML view of the elbow of the same dog. Note the displacement of both condyles (compare with Figure 13.20b , in which only the lateral condyle is displaced).
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13.22 (a) CrCd view of the elbow of a 6-month-old Pug with an elbow injury that occurred 6 weeks previously and was not treated, resulting in malunion. The fracture involved the medial condyle, which is now malformed and displaced medially with a resultant intercondylar non-union fracture with a 6 mm-wide gap. (b) ML view of the elbow of the same dog.
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13.23 (a) ML extended elbow view of a skeletally mature dog with a recent Monteggia fracture. (b) ML extended view of the elbow of a 3-month-old puppy bitten 2 weeks previously and not treated at the time. There is a Monteggia fracture with marked incomplete caudal ulna callus formation which will result in malunion.
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13.24 ML view of the elbow of an 11-year-old Border Collie with chronic elbow lameness and swelling. Note the soft tissue swelling with focal avulsed olecranon fragment, as well as the dystrophic mineralization of the tissues cranial to the fragment (injured triceps tendon).
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13.25 Cr15°L-CdMO view of the elbow of a skeletally immature dog with an avulsion fracture of part of the medial epicondyle.
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13.26 (a) CdCr view of the elbow of a skeletally mature Staffordshire Bull Terrier with complete elbow luxation. Specks of the avulsion fragment were seen on the original film. (b) ML view of the elbow of the same dog.
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13.27 CrCd view of the elbow of a skeletally mature dog with elbow subluxation. An avulsion fragment speck was seen adjacent to the medial epicondyle on the original film.
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13.28 (a) ML view of the elbow in a 5-month-old Labrador Retriever with premature closure of the distal ulnar physis, secondary widening of the humeroulnar joint space and a distally displaced medial coronoid process (arrowed). (b) CrCd view of the elbow of the same dog showing the widened humeroulnar joint space (arrowed).
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13.29 ML view of the elbow of a skeletally immature dog with premature closure of the distal radial physis and secondary widening of the humeroradial joint space.
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13.30 (a) ML semi-extended view of the elbow of a skeletally immature dog with congenital ulnar luxation. (b) CrCd view of the elbow of the same dog.
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13.31 (a) ML flexed view of the elbow of a 5-month-old Jack Russell Terrier with congenital radial luxation. (b) CrCd view of the elbow of the same dog.
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13.32 Interrelationship between elbow dysplasia and elbow osteoarthrosis. FMCP = fragmented medial coronoid process; OCD = osteochondritis dissecans; UAP = ununited anconeal process. (Adapted from , with permission from the )
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13.33 Location of osteophytic reactions on various views.
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13.34 (a) ML view of the elbow showing osteophyte formation on the anconeal process and additional osteophytic reactions on the lateral epicondylar crest and dorsal aspect of the joint. (b) CrCd view of the elbow of the same dog showing osteophytes.
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13.35 ML semi-extended view of the elbow of an 8-month-old German Shepherd Dog with a triangular medial coronoid fragment.
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13.36 ML semi-extended view of the elbow of a 1-year-old Rottweiler with a rounded medial coronoid process.
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13.37 ML flexed view of the elbow of a skeletally mature dog with an absent or flattened medial coronoid process. Note early osteophyte formation on the anconeal process.
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13.38 (a) ML extended view of the elbow of a 4-year-old Rottweiler with a large separate medial coronoid fragment superimposed on the cranial radius (arrowed). Osteophytic reactions are seen on the cranial margins of the joint and on the anconeal process and suntrochlear sclerosis. (b) Cr15°L-CdMO view of the elbow of the same dog with the triangular medial coronoid fragment (arrowed) seen with adjacent ulnar and medial epicondyle osteophytes. The fragment has probably grown over time.
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13.40 (a) Dorsal view of a bone-phase nuclear medicine study of a 9-year-old Labrador Retriever with left thoracic limb lameness of 2 months’ duration and normal radiographs. Note the increased radiopharmaceutical uptake in the left elbow region. (b) Close-up lateral view showing the increased radiopharmaceutical uptake to be in the proximal radius area (the region of the medial coronoid process).
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13.41 (a–m) A variety of CT images showing elbow dysplasia conditions.
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13.42 Cr15°L-CdMO view of the elbow of an 8-month-old Boerboel with an OCD lesion on the medial humeral condyle. Note the break in the continuity of the subchondral bone, faint mineralized cartilage flap (arrowed) and triangular radiolucency extending proximally. There was also a FMCP, which is not visible on this view.
Image of 13.43
13.43 (a) ML extended view of the right elbow of a 6-month-old German Shepherd Dog. The left elbow was normal. Note the irregularly wide vertical radiolucent line in the anconeal process. The humeroanconeal joint space is slightly widened, indicating minor displacement of the anconeal process. (b) ML extended view of the right elbow at 7.5 months of age. (c) ML extended view of the right elbow at 9 months, after ulna osteotomy with fusion of the UAP.
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13.44 ML view of the elbow of a 6-month-old German Shepherd Dog with an incomplete UAP. Given time, the anconeal process could still fuse completely.
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13.45 (a) ML semi-extended view of the elbow of a 2-year-old Boerboel with a UAP (arrowed), a FMCP and moderate osteoarthrosis. (b) Cr15°L-CdMO view of the elbow of the same dog to illustrate the separate medial coronoid fragment (arrowed) accompanied by osteophytic reactions on the remaining medial coronoid process.
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13.47 (a) CrCd view of the elbow of a 6-year-old Labrador Retriever with an ununited medial humeral epicondyle. The pathology was not visible on the ML view. (b) Transverse CT image of the elbow of the same dog in a bone window showing the ununited fragments. (Courtesy of Ghent University)
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13.48 (a) ML view of the elbow of a 4-year-old Boerboel. Note the slight spur formation (white arrow) and the associated irregular medial epicondyle superimposed on the anconeal process, as well as the dystrophic mineralization of the proximal flexor muscles (black arrow) superimposed on the proximal olecranon. (b) CrCd view of the elbow of the same dog. The dystrophic flexor muscle mineralization is seen between the arrows.
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13.49 ML flexed view of the elbow of a cat with an early medial epicondylar spur and mineralization of the adjacent flexor tendon.
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13.50 Elbow of a 6-year-old Rottweiler with flexor enthesopathy diagnosed using a variety of imaging modalities. (a) ML radiographic view. There are minimal medial epicondylar changes and mild arthrosis, probably secondary to a FMCP. (b) CrCd view showing marked dystrophic mineralization of the flexor muscles distomedial to the medial coronoid process. (c) Sagittal ultrasonogram of the medial aspect of the elbow. Proximal is to the left of the image. The flexor carpi ulnare (FCU) is slightly swollen and anechoic at its origin on the irregularly outlined medial epicondyle (arrowed). Dystrophic mineralization can be seen deep to the tendon (below the FCU) as a displaced echogenic line. Superficially, the medial aspect of the superficial digital flexor tendon (SDFT) can be seen. (d) Transverse CT image (bone window) of the distal humerus. Note the flexor origin medial epicondyle enthesopathy with immature new bone formation (arrowed). (e) Transverse post-contrast CT image (soft tissue window) of the distal humerus at the same level as (d). Note the flexor origin inflammation, visible as peripheral contrast enhancement (arrowed) with centrally non-enhancing oedema. The contrast-enhancing structure cranially is the saphenous vein. (f) Transverse T1W MR image of the distal humerus. Note the hyperintensity of the flexor origin area (arrowed), indicative of inflammation. (g) Transverse T1W post-contrast MR image at the same level as (f). Note the increased hyperintensity of the flexor origin area (arrowed) compared with the pre-contrast image. (Courtesy of Ghent University)
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13.51 (a) CrCd view of the right elbow of an 8-year-old Springer Spaniel presented with a long oblique fracture of the humerus. Incidental incomplete ossification of the humeral condyles is present (arrowed). (b) Left elbow of the same dog with a prominent radiolucent line of incomplete ossification of the humeral condyles (arrowed). Extensive osteoarthrosis is present, but is not related to the incomplete ossification.
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13.52 Transverse CT image (bone window) of the elbow of a 3-year-old Springer Spaniel with incomplete ossification of the humeral condyles.
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13.53 (a) ML view of the elbow of a Basset Hound with marked elbow incongruity. (b) ML view of the elbow of the same dog after ulna ostectomy. Note the marked decrease in incongruity.
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13.54 (a) ML view of the right elbow of an 8-month-old Rottweiler with acute-onset elbow lameness. Note the abnormal olecranon. (b) CrCd, (c) Cr15oL-CdMO and (d) Cr45oM-CdLO views of the same elbow. Note that the typical patella cubiti (trauma-related apophyseal avulsion without marked proximal displacement) is only seen on the supinated view. (e) ML postoperative view of the right elbow of the same dog. (f) ML view of the normal contralateral elbow of the same dog. Note the value of multiple views when the interpretation of standard orthogonal views is difficult.
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13.55 (a) ML view of the elbow of a 7-year-old Rottweiler with extensive long-standing arthrosis secondary to a FMCP. The soft tissue swelling over the olecranon is due to callus. Note how the osteophytic reactions on the lateral epicondylar crest extend beyond the medial epicondylar crest and superimpose caudally on the extensive osteophytic reaction on the anconeal process. There are also marked osteophytic reactions cranial to the joint. (b) Cr15oL-CdMO view of the elbow of the same dog.
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13.56 ML views of the elbow of an 8-year-old Basset Hound with chronic septic arthritis treated over an extensive period with lavage and antibiotics. (a) Extensive periarticular new bone formation with the humeroulnar joint reasonably spared. (b) Same view 11 weeks later, with progression of the new bone formation and marked humeroulnar subchondral lysis indicative of non-responsive infection. (Courtesy of Tygerberg Animal Hospital, Cape Town)
Image of 13.57
13.57 (a) ML view of the left elbow of a 6-year-old cat with a rapidly growing, non-painful, solitary juxta-articular mass on the craniolateral elbow, which was confirmed to be an extraskeletal osteochondroma. (b) CrCd and (c) Cr15oL-CdMO views of the same elbow. Note that the mineralized mass can only be seen as a structure separated from the underlying bone on the oblique view, thus allowing easy surgical removal. Incidental mineralized flexor enthesopathy is present. (d) CrCd view of the same elbow following surgery. (Courtesy of C Rosa)

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