Elbow - Medial View
How to perform the examination
Patient Positioning
Primary position (recommended): the patient is seated with the upper limb resting on a table, the elbow flexed at 90 degrees, and the forearm in supination to fully expose the medial compartment. The arm should be abducted approximately 30–45 degrees to allow optimal access to the medial epicondylar structures and the cubital tunnel.
Alternative position: the patient can be positioned supine with the upper limb abducted and the elbow flexed at 120 degrees. The forearm should be placed in supination to optimize visualization of the ulnar collateral ligament. This position facilitates dynamic examination under valgus stress.
Anatomy to Identify
- Medial epicondyle (flexor tendinopathies, calcifications, erosions)
- Humeral trochlea (cartilage erosions, bone alterations)
- Medial coronoid process (fractures, irregularities, osteophytes)
- Ulnar collateral ligament (lesions, laxity, thickening)
- Ulnar nerve (compressions, morphological alterations, subluxations)
- Medial epicondylar tendons (medial epicondylitis, partial tears)
Probe
High-frequency linear transducer (10–15 MHz) optimal for imaging the superficial structures of the medial compartment. Beam steering techniques are essential to minimize anisotropy of the ulnar collateral ligament. Doppler imaging is crucial for evaluating synovial vascularization and hyperemia in medial epicondylitis. Frequency modulation allows optimal analysis from superficial tendinous structures to deeper joints.
Anatomical Zones
Medial epicondyle
The medial epicondyle (epitrochlea) of the humerus represents the origin site of the flexor muscles of the forearm and hand. In hemophilic arthropathy, this region may develop inflammatory and degenerative changes due to biomechanical alterations and compensatory stresses that occur secondary to chronic joint disease.
Characteristic: Medial bony prominence more pronounced than the lateral one; insertion of common flexor tendons
Findings:
- Secondary medial epicondylitis: Inflammation of the flexor tendons due to biomechanical compensation.
- Chronic enthesopathy: Thickening and structural alterations of the tendons at the epitrochlear insertion.
- Periarticular calcifications: Calcific deposits in the epicondylar soft tissues due to chronic inflammatory processes.
- Bone erosions: Irregularities of the epicondylar profile caused by recurrent inflammatory processes.
Probe Positioning
Place the probe longitudinally on the medial epicondyle of the humerus, following the course of the flexor tendons. The marker should be oriented proximally toward the arm. It is important to use gentle pressure to avoid compressing the ulnar nerve within the cubital tunnel.
Humeral trochlea
The humeral trochlea is the medial articular surface of the distal humerus that articulates with the semilunar notch of the ulna, forming the ulnohumeral joint. In hemophilic arthropathy, this structure is one of the most frequently and earliest affected sites by erosive processes, due to its intra-articular position and direct exposure to hemorrhagic events.
Characteristic: Pulley-shaped surface; primary articulation for flexion-extension movements
Findings:
- Extensive cartilage erosions: Progressive loss of articular cartilage with exposure of the subchondral bone.
- Morphological alterations: Deformities of the trochlear surface due to erosive and reparative processes.
- Marginal osteophytes: Osteophytic formations at the edges of the trochlea as a response to degenerative processes.
- Intra-articular loose bodies: Osteochondral fragments resulting from the erosion of articular surfaces.
Probe Positioning
Perform longitudinal and transverse scans at the level of the ulnohumeral joint. The probe should be positioned posterior to the medial epicondyle to visualize the articulation between the trochlea and the semilunar notch of the ulna.
Clinical Cases by Severity grade
The clinical cases are organized according to the HEAD-US protocol (Head-to-Head Assessment of Ultrasound Score), which classifies the severity of hemophilic arthropathy into four levels. Click on each level to explore the available cases for that specific joint–projection combination.