Non-traumatic Elbow Joint Effusion

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Non-traumatic Elbow Joint Effusion

Authors, Editors, Case Information Author: Miguel Agrait Gonzalez, MD CAQ-SM Affiliation: Centro Medico Episcopal San Lucas Ponce Co Author(s): Adriana Mercado MD Kevina Laureano Cruz MD Senior Editor: Derek Stokes, MD Clinical Vignette: A previously healthy 35-year-old male presented with atraumatic right elbow pain for 2 weeks which began after starting an intense tennis training regimen. He had developed acute worsening of pain with new limitation in elbow extension prompting visit for evaluation. He denied previous injuries to the elbow, and denied history of inflammatory arthropathy. Ultrasound-guided arthrocentesis was performed which yielded 12mL of purulent material. He was eventually diagnosed with septic arthritis of the elbow. Type of Probe Used: MSK Setting Virtual Linear Transducer Unlabeled long axis view of the olecranon fossa Unlabeled long axis image of the olecranon fossa. Labeled long axis view of the olecranon fossa Labeled long axis image of the olecranon fossa with evidence of a large elbow joint effusion and elevation of the olecranon fat pad visualized inferior to the triceps tendon and muscle which are located in the near field of the image. There is displacement of the posterior fat pad seen in the image. Unlabeled short axis view of the olecranon fossa Unlabeled short axis view of the olecranon fossa Labeled short axis view of the olecranon fossa. Labeled short axis view of the olecranon fossa with evidence of effusion deep to triceps muscle and olecranon fat pad Unlabeled short axis view of the olecranon fossa post-arthrocentesis Unlabeled short axis view of the olecranon fossa post-arthrocentesis. Labeled short axis view of the olecranon fossa post-arthrocentesis Labeled short axis view of the olecranon fossa shortly after arthrocentesis with no hypoechoic collection inferior to the triceps and olecranon fat pad confirming complete drainage of effusion. Interpretation Image Interpretation: There is a large joint effusion visualized in the olecranon fossa of the elbow joint. The triceps tendon appears normal, there is no evidence of olecranon bursitis present. Teaching Pearl: The posterior elbow, specifically the olecranon fossa or posterior recess, is the most sensitive sonographic location for detecting an elbow joint effusion. Fluid deep to the triceps tendon in this recess should be distinguished from olecranon bursitis, which is superficial and extra-articular. A nontraumatic effusion should prompt clinical consideration of inflammatory arthritis, crystal-related disease (CPPD and gout), infection, occult fracture, or internal derangement. If aspiration is needed, ultrasound can confirm the effusion pocket and guide a safe posterior approach. References: 1. De Maeseneer M, Jacobson JA, Jaovisidha S, et al. Elbow effusions: distribution of joint fluid with flexion and extension and imaging implications. Invest Radiol. 1998;33(2):117-125. doi:10.1097/00004424-199802000-00010 2. Konin GP, Nazarian LN, Walz DM. US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics. 2013;33(4):E125-E147. doi:10.1148/rg.334125059 3. Boniface KS, Ajmera K, Cohen JS, Liu YT, Shokoohi H. Ultrasound-guided arthrocentesis of the elbow: a posterior approach. J Emerg Med. 2013;45(5):698-701. doi:10.1016/j.jemermed.2013.04.053
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Unlabeled long axis view of the olecranon fossa

Labeled long axis view of the olecranon fossa

Unlabeled short axis view of the olecranon fossa

Labeled short axis view of the olecranon fossa.

Unlabeled short axis view of the olecranon fossa post-arthrocentesis

Labeled short axis view of the olecranon fossa post-arthrocentesis

Interpretation

UPCOMING EVENTS

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