The posterior transtriceps approach for elbow arthrography: a forgotten technique?
OBJECTIVE
To evaluate the technical feasibility of performing elbow MR arthrography via a posterior approach through the triceps.


METHODS
The images of 19 patients with elbow MR arthrography via a posterior transtriceps approach were retrospectively studied. The injections were performed by four musculoskeletal radiologists, using fluoroscopic guidance and a 22- or 25-gauge needle. The fluoroscopic and subsequent MR images were reviewed by two musculoskeletal radiologists and evaluated for adequacy of joint capsular distention, degree and location of contrast leakage, and presence of gas bubbles.


RESULTS
The injection was diagnostic in all 19 patients, with a sufficient amount of contrast agent seen in the elbow joint. No significant contrast leakage occurred in 12 patients who received injections of 8 cc or less of contrast agent, but moderate contrast leakage occurred in 6/7 patients who received injections of greater than 8 cc. Contrast leakage generally occurred within the triceps myotendinous junction. No gas bubbles were identified in the injected joints.


CONCLUSIONS
Patients often present for MR arthrography of the elbow with medial or lateral elbow pain. Contrast leakage during a radiocapitellar approach may complicate evaluation of the lateral collateral ligament or the common extensor tendon origin. Transtriceps MR arthrography offers an alternative to the more commonly used radiocapitellar approach. With injected volumes not exceeding 8 cc, the risk of significant contrast leakage is small. An advantage of the transtriceps injection is that contrast leakage through the posterior needle tract does not interfere with evaluation of the lateral structures.
Lohman
M
M
Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA. lohmancm@upmc.edu
Borrero
C
C
Casagranda
B
B
Rafiee
B
B
Towers
J
J
D003287:Contrast Media / Q000008:administration & dosage; D004551:Elbow Joint / Q000473:pathology*; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012189:Retrospective Studies
D003287:Contrast Media