hi everyone I'm Dr Muhammad bardi I'm a practicing rumatologist in Vancouver British Columbia so now we're going to go look at the Joint from the posterior aspect we want to look for any sort of joint diffusion sinovitis and then we'll assess the tricep uh insertion for enthesitis or enthesopathy small joint diffusions will initially accumulate in the posterior aspect of the elbow and as the effusion progresses you'll see it more in the anterior view but this is more sensitive to look at the posterior aspect so we're going to put our probe down you want to make sure your depth is well adjusted so you can see the Bony cortex of the humoris that bright white line superficial to that you're going to see the tricep muscle belly and as I start to come down you'll see this kind of dip in the bone there's a little fat pad in there and that is the elron fossa and then you'll see the Bony structure this is if you're more lateral that'll be part of the capitulum if you're more medial this will be part of the tra and then you'll see the elron here as well and you can see the myotendinous junction more superficially of the tricep of the triceps here so let's start with a assessment for any sort of joint diffusion so as you move medial to lateral and you can see this kind of joint space right here between the elron and where it's the tra or the capitulum if there's a small joint diffusion that's where you'll see it if you were looking for sinovial thickening and proliferation it would extend out of that space and drop down towards the electron f and displace that fat pad as well really important if you were looking for with Doppler and I'll show you how the Doppler assessment looks in a moment and if you were coming further down distally we want to look at the triceps as it comes all the way down to its insertion here to really get a good view of the enthesis now if you just look at this and I'll use a bit more gel it's helpful to have a standoff layer here when you come here you see how I've tilted the probe to get the distal fibers well assessed if you just look at it like this you'll have a lot of anosy tropy because of how the tendons are oriented so you do need to tilt your probe you do need a good gel there to maintain contact okay and keeping staying light on the pressure as we've discussed and sweeping again I'm going from medial to lateral you want to see these structures you want to see if there's any sort of loss of fibrillation calcification thickening erosions on the bone surface and Doppler signal as well so if we were to turn on our Doppler you want to make sure your your Doppler box is in the field of Interest so looking through the enthesis here as I'm sweeping around and if we were to look for the cium if there was sinovitis here it's this area of interest you may need to increase the depth of your Doppler box if needed and remembering to keep the prf around 1,000 khz and sometimes you do need to address your color gain so you have a little bit of background activity again and you want your Doppler box from this top of the image down to the area of interest if you were looking at these structures in transverse if you start proximally you can see the tricep muscle belly you can see the Bony structures as you come down distally you'll see this kind of u-shaped appearance to the space here you'll see the Kon FSA that's where the fat pad is located so if there was an infusion or citis you'd see a lifting off of that and you'd see more hypoc coic changes as I go disty further further further further I'm on the electron you can see that black an aoic layer that's the cartilage from the back here as well okay so you want to look through that if you were to follow if you follow the tricep muscle you can see how it's converging onto the tendon if you're not sure where the tendon is you can use an ayop to help you bring that in and out of view View and you can see all the way at the distal insertion here again if you were looking here with Doppler bring your box to the region of Interest keep the pressure light you can tilt the probe you can look through the Bony cortex look for any sort of erosions look for any sort of Doppler signal back here as you interrogate that that concludes the elbow scan
