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The posterior transtriceps approach for elbow arthrography: a forgotten technique?
M Lohman1, C Borrero, B Casagranda
1Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA. lohmancm@upmc.edu
Skeletal Radiology
|February 3, 2009
Summary
Posterior elbow MR arthrography via the triceps is technically feasible. This transtriceps approach minimizes contrast leakage, especially with volumes under 8 cc, aiding evaluation of lateral elbow structures.
Area of Science:
- Radiology
- Musculoskeletal Imaging
Background:
- Elbow MR arthrography is crucial for diagnosing medial and lateral elbow pain.
- The standard radiocapitellar approach can obscure evaluation of lateral structures due to contrast leakage.
Purpose of the Study:
- To assess the technical feasibility of elbow MR arthrography using a posterior transtriceps approach.
Main Methods:
- Retrospective review of 19 elbow MR arthrograms performed via a posterior transtriceps approach.
- Injections guided by fluoroscopy using 22- or 25-gauge needles.
- Radiologists evaluated joint distention, contrast leakage, and gas bubbles on fluoroscopic and MR images.
Main Results:
- All 19 injections were diagnostic with adequate joint distention.
- Contrast leakage was minimal (<8 cc) in 12 patients; moderate leakage occurred in 6/7 patients (>8 cc), typically at the triceps myotendinous junction.
- No gas bubbles were observed.
Conclusions:
- The transtriceps approach is a viable alternative to the radiocapitellar route for elbow MR arthrography.
- Limiting injected contrast volume to 8 cc or less significantly reduces leakage risk.
- Posterior leakage does not impede visualization of lateral elbow structures.
