This lecture will discuss the more challenging aspects of elbow sonographic assessment. The biceps brachii tendon insertion onto the radial tuberosity is an area which is traditionally difficult to assess with ultrasound. A variety of factors including anisotropy, deep location and poor quality acoustic window through muscle belly edges result in a technical challenge. A method of sonographic assessment using the pronator teres muscle belly as an acoustic window will be demonstrated allowing high resolution assessment of the tendon insertion and musculotendinous junction. This technique allows the examination to be extended beyond intact / ruptured differentiation to include more subtle findings such as tendonosis and partial tears and avulsions. The resulting images are of high resolution and diagnostic quality allowing visualization of the normal periosteal fibrocartilage at the tendon enthesis. The bicipitoradial bursa is also easily assessed and injected / aspirated with application of the technique.

Assessment of the elbow medial and lateral collateral ligament apparatus is an important extension to routine golfers or tennis elbow examinations respectively. Sonographic technique for assessment of the collateral ligament structures will be discussed including diagnostic clues and provocative tests which assist the diagnosis of ligament failure.