Imaging of posttraumatic and soft tissue dysfunction of the elbow

The inherent obliquity of the elbow produces a challenge to the radiologist. In the treatment of elbow trauma, comprehensive evaluation includes detection of bone, cartilage, ligament, and tendon injury. In most cases, plain radiographs remain the initial imaging mainstay for evaluation of the elbow, followed by properly performed magnetic resonance imaging with thin (1.5-2 mm) sections and appropriate pulse sequencing to provide differential contrast between subchondral bone, cartilage, and joint fluid. Vigilant attention to imaging technique obviates the need for additional intraarticular contrast agent, which converts the magnetic resonance imaging to an invasive procedure and, in many cases, increases the cost. The advent of magnetic resonance angiography has provided an important noninvasive diagnostic means to detect associated vascular injury. In addition, computed tomography imaging, particularly with concomitant three-dimensional reformations, provides comprehensive fracture assessment. Postprocessing capabilities include rotation of three-dimensional models and subtraction programs that may be useful in disclosing subtle fracture components. Finally, ultrasound increasingly is being accepted as an important imaging modality by which to detect tendinous and soft tissue injury and has the distinct advantage of being able to impart dynamic load to muscle tendon units.