Imaging Field of View for Elbow Injury
No, imaging should be limited to the elbow and proximal forearm region, not the entire arm. 1111
Recommended Imaging Area
The 2024 ACR Appropriateness Criteria explicitly specify "elbow/proximal forearm" as the appropriate area of interest for both ultrasound and MRI when evaluating suspected tendon, ligament, or muscle injuries following elbow trauma. 1111
Key Anatomic Structures to Include
The imaging field should encompass:
- Distal biceps and triceps tendons - These insert at the proximal forearm/elbow and are common injury sites in eccentric loading mechanisms like pickleball
- Medial and lateral collateral ligament complexes - Critical stabilizers frequently injured in elbow trauma
- Common extensor and flexor tendon origins at the epicondyles
- Anterior joint capsule - Often torn in elbow dislocations
Why Not the Entire Arm?
There is no evidence supporting imaging of the entire arm for isolated elbow injuries. 111 The ACR guidelines consistently recommend focused imaging of the elbow/proximal forearm region because:
- All relevant soft tissue structures for elbow injuries are contained within this region
- Distal biceps pathology is best visualized with specialized sequences (FABS view) focused on the elbow, not full arm imaging 111
- Extending imaging unnecessarily increases cost, scan time, and patient discomfort without diagnostic benefit
Clinical Context for This Patient
In a 78-year-old with eccentric elbow injury from pickleball:
- Distal biceps tendon injury is a primary concern - this requires focused elbow/proximal forearm imaging with possible FABS positioning 11
- Collateral ligament injuries are common in sports-related elbow trauma and are well-evaluated with focused elbow MRI (87.5-90.9% concordance with surgical findings) 111
- The absence of current symptoms does NOT exclude significant injury - MRI can detect occult ligamentous and tendinous pathology 1
Practical Imaging Protocol
For MRI: Order "MRI elbow without contrast" - this is the appropriate study per ACR guidelines 1111
For Ultrasound: Request "ultrasound elbow" focusing on distal biceps, triceps, and collateral ligaments 12
The radiologist will automatically include the proximal forearm in standard elbow protocols to adequately visualize the distal biceps insertion and other relevant structures.