What X-rays should be ordered for a patient with left bicep pain and a history of falling on their left elbow, with pain radiating to the forearm?

X-Ray Recommendations for Left Bicep Pain After Elbow Fall

For a patient with left bicep pain after falling on the elbow with radiation to the forearm, plain radiographs of the elbow should be ordered as the initial imaging study, including anteroposterior (AP), lateral, and oblique views. 1

Initial Imaging Approach

• Plain radiographs of the elbow are the appropriate first-line imaging modality for evaluation of acute elbow pain following trauma 1
• Standard radiographic views should include:
  • Anteroposterior (AP) view
  • Lateral view
  • Oblique view 1
• These views allow assessment of potential fractures, dislocations, and joint effusions that may be causing the radiating pain 1

Clinical Rationale for Elbow X-rays

• The patient's history of falling on the elbow with pain radiating to the forearm and bicep suggests potential bone or soft tissue injury that should first be evaluated with plain films 1
• Radiographs can identify:
  • Radial head/neck fractures (most common elbow fracture, accounting for 50% of cases) 1
  • Olecranon fractures
  • Joint effusions (visible as posterior and anterior fat pad elevation) 1
  • Avulsion fractures at tendon or ligament attachment sites 1

Interpretation Considerations

• An elbow joint effusion identified on radiographs (fat pad signs) in the context of trauma may indicate an occult fracture even if no fracture line is visible 1
• Pay particular attention to:
  • Radial head (common fracture site)
  • Coronoid process (may indicate prior dislocation)
  • Olecranon (may show avulsion fractures from triceps tendon tears) 1

Follow-up Imaging Considerations

• If radiographs are normal or indeterminate but clinical suspicion for fracture remains high:

  • CT without contrast would be the next appropriate study 1
  • CT is particularly useful for identifying occult fractures of the radial head, olecranon, and coronoid process 1

• If soft tissue injury (tendon/ligament) is suspected and radiographs are normal:

  • MRI without contrast would be the appropriate next step 1
  • MRI is particularly useful for evaluating biceps tendon tears, which may be causing the bicep pain 1

Common Pitfalls to Avoid

• Do not delay obtaining radiographs in a patient with trauma and localized pain, as early diagnosis can prevent complications 2
• Avoid ordering unnecessary advanced imaging before obtaining plain radiographs first 1
• Remember that not all fractures are visible on initial radiographs; clinical correlation is essential 1
• Do not miss evaluating for joint effusion (fat pad signs), which may be the only radiographic indication of an occult fracture 1

By following this approach, you can efficiently evaluate the patient's elbow pain while minimizing unnecessary radiation exposure and healthcare costs.