Which projection of the elbow best demonstrates the radial head free of superimposition of the ulna?

Citation, DOI & article data

Citation:

Shetty, A., Murphy, A. Elbow series. Reference article, Radiopaedia.org. (accessed on 08 Sep 2022) https://doi.org/10.53347/rID-31131

The elbow series is a set of radiographs taken to investigate elbow joint pathology, often in the context of trauma. It usually comprises an AP and lateral projection, although other non-standard, modified projections are utilized for specific indications.

Indications

Elbow x-rays are indicated for a variety of settings including:

• trauma
• bony tenderness
• suspected fracture of the proximal radius and ulna
• suspected fracture of the distal humerus
• radial head dislocations
• obvious deformity
• detecting joint effusions
• arthritis
• infection

Projections

Standard projections

• AP
  • demonstrates distal humerus, proximal ulna, and radius
  • shows both the medial and lateral epicondyles in profile
• lateral
  • best demonstrates the ulna-trochlear joint, coronoid process, and the olecranon process
  • used to assess both the anterior humeral line and the radiocapitellar line

Modified trauma projections

• horizontal beam lateral
  • modified lateral projection that requires little to no patient movement
  • produces a diagnostic lateral/AP projection without risking patient pain
• acute flexion AP
  • modified AP projection when the patient cannot straighten the arm 
• inferosuperior view
  • modified elbow projection for patients in acute flexion greater than 90 degrees

Additional projections

• Coyle's view
  • an axial projection that focuses on the radial head, used when radial head fractures are suspected 
• external oblique
  • an additional projection often performed to demonstrate the radial head free from superimposition
• internal oblique view
  • projection demonstrating the coronoid process in profile 
• supracondylar AP

Quiz questions

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