Download PDF
Semin Musculoskelet Radiol 2021; 25(04): 546-557
DOI: 10.1055/s-0041-1729960
Review Article

Elbow Imaging: Variants and Asymptomatic Findings

Neha Antil
1   Division of Musculoskeletal Imaging, Department of Radiology, Stanford University, School of Medicine, Stanford, California
,
Kathryn J. Stevens
1   Division of Musculoskeletal Imaging, Department of Radiology, Stanford University, School of Medicine, Stanford, California
,
Amelie M. Lutz 
1   Division of Musculoskeletal Imaging, Department of Radiology, Stanford University, School of Medicine, Stanford, California
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

One of the key principles in the interpretation of radiology images is the ability to differentiate between normal and abnormal findings. This article provides a comprehensive overview of normal structures and anatomical variants occurring around the elbow including potential diagnostic pitfalls. We discuss frequently observed anatomical variants found in routine clinical practice associated with osseous, ligamentous, musculotendinous, and neurovascular structures at the elbow that may simulate pathology or predispose to symptoms under specific circumstances.

Keywords

elbow - normal - anatomical variants - pitfalls


Publication History

Article published online:
27 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Tomsick SD, Petersen BD. Normal anatomy and anatomical variants of the elbow. Semin Musculoskelet Radiol 2010; 14 (04) 379-393
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Stein JM, Cook TS, Simonson S, Kim W. Normal and variant anatomy of the elbow on magnetic resonance imaging. Magn Reson Imaging Clin N Am 2011; 19 (03) 609-619
    CrossrefPubMedGoogle Scholar
  • 3 Freyschmidt J, Brossmann J. “Freyschmidt's Koehler/Zimmer” Borderlands of Normal and Early Pathologic Findings in Skeletal Radiography. Stuttgart, Germany: Thieme; 2003
    Google Scholar
  • 4 Rosenberg ZS, Bencardino J, Beltran J. MR imaging of normal variants and interpretation pitfalls of the elbow. Magn Reson Imaging Clin N Am 1997; 5 (03) 481-499
    CrossrefPubMedGoogle Scholar
  • 5 Rosenberg ZS, Beltran J, Cheung Y, Broker M. MR imaging of the elbow: normal variant and potential diagnostic pitfalls of the trochlear groove and cubital tunnel. AJR Am J Roentgenol 1995; 164 (02) 415-418
    CrossrefPubMedGoogle Scholar
  • 6 Singhal S, Rao V. Supratrochlear foramen of the humerus. Anat Sci Int 2007; 82 (02) 105-107
    CrossrefPubMedGoogle Scholar
  • 7 Erdogmus S, Guler M, Eroglu S, Duran N. The importance of the supratrochlear foramen of the humerus in humans: an anatomical study. Med Sci Monit 2014; 20: 2643-2650
    CrossrefPubMedGoogle Scholar
  • 8 Hirsch IS. On a foramen in the lower extremity of the humerus. Radiology 1928; 10 (03) 199-208
    CrossrefPubMedGoogle Scholar
  • 9 Nayak SR, Das S, Krishnamurthy A, Prabhu LV, Potu BK. Supratrochlear foramen of the humerus: an anatomico-radiological study with clinical implications. Ups J Med Sci 2009; 114 (02) 90-94
    CrossrefPubMedGoogle Scholar
  • 10 Mittal R, Sampath Kumar V, Gupta T. Patella cubiti: a case report and literature review. Arch Orthop Trauma Surg 2014; 134 (04) 467-471
    CrossrefPubMedGoogle Scholar
  • 11 Khomarwut K, Sutthisast W, Vasuntaraporn U, Arpornchayanon O. Bilateral patellar CUBITI: a case report. Bangk Med J 2019; 15 (01) 91-93
    CrossrefPubMedGoogle Scholar
  • 12 Pavlov H, Torg JS, Jacobs B, Vigorita V. Nonunion of olecranon epiphysis: two cases in adolescent baseball pitchers. AJR Am J Roentgenol 1981; 136 (04) 819-820
    CrossrefPubMedGoogle Scholar
  • 13 Obermann WR, Loose HW. The os supratrochleare dorsale: a normal variant that may cause symptoms. AJR Am J Roentgenol 1983; 141 (01) 123-127
    CrossrefPubMedGoogle Scholar
  • 14 Shon HC, Park JK, Kim DS, Kang SW, Kim KJ, Hong SH. Supracondylar process syndrome: two cases of median nerve neuropathy due to compression by the ligament of Struthers. J Pain Res 2018; 11: 803-807
    CrossrefPubMedGoogle Scholar
  • 15 Grayson DE. The elbow: radiographic imaging pearls and pitfalls. Semin Roentgenol 2005; 40 (03) 223-247
    CrossrefPubMedGoogle Scholar
  • 16 Newman A. The supracondylar process and its fracture. AJR Am J Roentgenol 1969; 105 (04) 844-849
    CrossrefPubMedGoogle Scholar
  • 17 Pećina M, Borić I, Anticević D. Intraoperatively proven anomalous Struthers' ligament diagnosed by MRI. Skeletal Radiol 2002; 31 (09) 532-535
    CrossrefPubMedGoogle Scholar
  • 18 Cucca YY, McLay SV, Okamoto T, Ecker J, McMenamin PG. The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat 2010; 32 (04) 371-375
    CrossrefPubMedGoogle Scholar
  • 19 Lee SE, Jung C, Ahn KY, Nam KI. Bilateral asymmetric supernumerary heads of biceps brachii. Anat Cell Biol 2011; 44 (03) 238-240
    CrossrefPubMedGoogle Scholar
  • 20 Tagliafico AS, Bignotti B, Martinoli C. Elbow US: anatomy, variants, and scanning technique. Radiology 2015; 275 (03) 636-650
    CrossrefPubMedGoogle Scholar
  • 21 Konin GP, Nazarian LN, Walz DM. US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics 2013; 33 (04) E125-E147
    CrossrefPubMedGoogle Scholar
  • 22 De Maeseneer M, Brigido MK, Antic M. et al. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol 2015; 84 (04) 671-681
    CrossrefPubMedGoogle Scholar
  • 23 Dirim B, Brouha SS, Pretterklieber ML. et al. Terminal bifurcation of the biceps brachii muscle and tendon: anatomic considerations and clinical implications. AJR Am J Roentgenol 2008; 191 (06) W248-W255
    CrossrefPubMedGoogle Scholar
  • 24 Mugalur A, Shahane SM, Samant A, Pathak AC, Patil A, Reddy R. Anatomic variation of palmaris longus and flexor digitorum superficialis of little finger in Indian population. SICOT J 2015; 1: 5
    CrossrefPubMedGoogle Scholar
  • 25 Olewnik Ł, Wysiadecki G, Polguj M, Podgórski M, Jezierski H, Topol M. Anatomical variations of the palmaris longus muscle including its relation to the median nerve—a proposal for a new classification. BMC Musculoskelet Disord 2017; 18 (01) 539
    CrossrefPubMedGoogle Scholar
  • 26 Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects—normal anatomy, variants, and pitfalls. Radiology 2009; 252 (01) 148-156
    CrossrefPubMedGoogle Scholar
  • 27 Kojima T, Kurihara K, Nagano T. A study on operative findings and pathogenic factors in ulnar neuropathy at the elbow. Handchirurgie 1979; 11 (02) 99-104
    PubMedGoogle Scholar
  • 28 Sookur PA, Naraghi AM, Bleakney RR, Jalan R, Chan O, White LM. Accessory muscles: anatomy, symptoms, and radiologic evaluation. Radiographics 2008; 28 (02) 481-499
    CrossrefPubMedGoogle Scholar
  • 29 Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol 2010; 195 (03) 585-594
    CrossrefPubMedGoogle Scholar
  • 30 Oh CS, Chung IH, Koh KS. Anatomical study of the accessory head of the flexor pollicis longus and the anterior interosseous nerve in Asians. Clin Anat 2000; 13 (06) 434-438
    CrossrefPubMedGoogle Scholar
  • 31 al-Qattan MM. Gantzer's muscle. An anatomical study of the accessory head of the flexor pollicis longus muscle. J Hand Surg [Br] 1996; 21 (02) 269-270
    CrossrefPubMedGoogle Scholar
  • 32 Caetano EB, Sabongi JJ, Vieira LÂ, Caetano MF, Moraes DV. Gantzer muscle. An anatomical study. Acta Ortop Bras 2015; 23 (02) 72-75
    CrossrefPubMedGoogle Scholar
  • 33 Chakravarthi KK. Gantzer's muscle an accessory muscle of forearm—its anatomical variations and clinical insight. International Journal of Chemical and Lifesciences. 2019; 2 (07) 1199-1203
    PubMedGoogle Scholar
  • 34 Loukas M, Louis Jr RG, South G, Alsheik E, Christopherson C. A case of an accessory brachialis muscle. Clin Anat 2006; 19 (06) 550-553
    CrossrefPubMedGoogle Scholar
  • 35 Akhtar MJ, Fatima N. An accessory brachialis muscle associated with abnormal arrangement of structures in the cubital fossa: a case report. International Journal of Research in Medical Sciences. 2015; 3 (12) 3907-3910
    CrossrefPubMedGoogle Scholar
  • 36 Pai MM, Nayak SR, Vadgaonkar R. et al. Accessory brachialis muscle: a case report. Morphologie 2008; 92 (296) 47-49
    CrossrefPubMedGoogle Scholar
  • 37 Stevens KJ, McNally EG. Magnetic resonance imaging of the elbow in athletes. Clin Sports Med 2010; 29 (04) 521-553
    CrossrefPubMedGoogle Scholar
  • 38 Munshi M, Pretterklieber ML, Chung CB. et al. Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analysis. Radiology 2004; 231 (03) 797-803
    CrossrefPubMedGoogle Scholar
  • 39 Acosta Batlle J, Cerezal L, López Parra MD, Alba B, Resano S, Blázquez Sánchez J. The elbow: review of anatomy and common collateral ligament complex pathology using MRI. Insights Imaging 2019; 10 (01) 43
    CrossrefPubMedGoogle Scholar
  • 40 Alcid JG, Ahmad CS, Lee TQ. Elbow anatomy and structural biomechanics. Clin Sports Med 2004; 23 (04) 503-517 , vii
    CrossrefPubMedGoogle Scholar
  • 41 Fowler KA, Chung CB. Normal MR imaging anatomy of the elbow. Radiol Clin North Am 2006; 44 (04) 553-567 , viii
    CrossrefPubMedGoogle Scholar
  • 42 Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 2000;20(Spec No):S199–S213; discussion S213–S217
    PubMedGoogle Scholar
  • 43 Bäumer P, Dombert T, Staub F. et al. Ulnar neuropathy at the elbow: MR neurography—nerve T2 signal increase and caliber. Radiology 2011; 260 (01) 199-206
    CrossrefPubMedGoogle Scholar
  • 44 Glover NM, Murphy PB. Anatomy, Shoulder and Upper Limb, Radial Nerve. Treasure Island, FL: StatPearls; 2020
    Google Scholar
  • 45 Jamadar DA, Robertson BL, Jacobson JA. et al. Musculoskeletal sonography: important imaging pitfalls. AJR Am J Roentgenol 2010; 194 (01) 216-225
    CrossrefPubMedGoogle Scholar
  • 46 Xiao TG, Cartwright MS. Ultrasound in the evaluation of radial neuropathies at the elbow. Front Neurol 2019; 10: 216
    CrossrefPubMedGoogle Scholar
  • 47 Hagert CG, Lundborg G, Hansen T. Entrapment of the posterior interosseous nerve. Scand J Plast Reconstr Surg 1977; 11 (03) 205-212
    CrossrefPubMedGoogle Scholar