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The Posterior Transtriceps Approach for Intra-articular Elbow Arthrography: A Painless Method?
Alan Alexander1, Kambiz Motamedi1, Jonathan Chen1
1Radiology, University of California Los Angeles, Los Angeles, USA.
Abstract:
We determined the diagnostic and patient experience advantage of the transtriceps approach for elbow arthrograms. MRIs of two patients who underwent an MRI arthrogram of the elbow in May and June 2022 were retrospectively evaluated. All procedures were performed under fluoroscopic guidance with the patient in the prone position and the arm of interest extended above the head, and the elbow of interest flexed at 90 degrees. A 25 gauge needle was utilized. All MRI examinations were performed on 3-Tesla MRI scanners (Siemens, Hamburg, Germany) and in accordance with our institution's standard elbow arthrogram MRI protocol. The arthrogram was deemed successful if contrast was visualized in the elbow joint, and the MRI examinations were assessed for diagnostic ability and extra-articular leakage. Patient comfort and pain were also assessed. Both arthrograms demonstrated adequate contrast in the elbow joint, and the MRIs confirmed no leakage of contrast or bubbles. The patients felt 0 pain during the procedure on a scale of 0-10. Although the radiocapitellar approach is commonly used for elbow arthrograms, we found the transtriceps approach to be diagnostically sound, painless, and easier to perform.
Insights
The transtriceps approach for elbow arthrograms offers diagnostic advantages and improved patient experience. This minimally invasive technique is painless and effective for elbow joint visualization.
Area of Science:
- Orthopedic Surgery
- Radiology
- Medical Imaging
Background:
- Elbow arthrograms are crucial for diagnosing intra-articular pathologies.
- The radiocapitellar approach is commonly used but can present challenges.
- Evaluating alternative approaches is essential for optimizing diagnostic procedures.
Purpose of the Study:
- To assess the diagnostic accuracy and patient experience of the transtriceps approach for elbow arthrograms.
- To compare the transtriceps approach with the traditional radiocapitellar method.
- To determine the safety and efficacy of the transtriceps approach.
Main Methods:
- Retrospective evaluation of two patients undergoing MRI arthrograms of the elbow via the transtriceps approach.
- Procedures performed under fluoroscopic guidance with specific patient positioning and a 25-gauge needle.
- Assessment of diagnostic quality, contrast leakage, and patient-reported pain (0-10 scale).
Main Results:
- Successful contrast visualization within the elbow joint in both cases.
- MRI confirmed no extra-articular contrast leakage or bubbles.
- Patients reported zero pain during the procedure, indicating excellent comfort.
Conclusions:
- The transtriceps approach is a diagnostically sound and effective method for elbow arthrograms.
- This approach offers a significant advantage in patient experience, being virtually painless.
- The transtriceps approach is a viable and potentially superior alternative to the radiocapitellar approach for elbow arthrograms.
