Variant 2: Adult. Acute elbow or forearm pain. Suspect fracture. Radiographs normal or indeterminate. Next imaging study. This variant is associated with osseous injury only. Please refer to Variant 3 for recommendations for the evaluation of soft tissue injury. Bone Scan Area of Interest There is no evidence to support the use of 3-phase bone scan as the initial imaging study for the evaluation of acute elbow and forearm pain. CT Area of Interest With IV Contrast There is no evidence to support the use of contrast-enhanced CT of the elbow/proximal forearm as the initial imaging study for the evaluation of acute elbow and forearm pain. CT Area of Interest Without and With IV Contrast There is no evidence to support the use of noncontrast/contrast-enhanced CT of the elbow/proximal forearm as the initial imaging study for the evaluation of acute elbow and forearm pain. In the elbow, the additional knowledge gleaned from CT includes size of fracture fragments and amount of displacement or angulation, which may affect the surgical treatment options. Isolated radial head fractures, Essex- Lopresti injuries, and Monteggia fractures with dislocation of the elbow can be diagnosed. Traumatic elbow injuries are categorized into radial head fracture with posterior dislocation, terrible triad injury, posterior and anterior fracture-dislocation, trans-olecranon (anterior) fracture-dislocation, and varus posteromedial rotational instability. Fracture mapping and quantitative 3-D CT analysis of coronoid and olecranon fractures have identified specific shapes, sizes, and orientations of fracture fragments according to a pattern of traumatic elbow instability.
Acute Elbow and Forearm Pain. Variant 2: Adult. Acute elbow or forearm pain. Suspect fracture. Radiographs normal or indeterminate. Next imaging study. This variant is associated with osseous injury only. Please refer to Variant 3 for recommendations for the evaluation of soft tissue injury. Bone Scan Area of Interest There is no evidence to support the use of 3-phase bone scan as the initial imaging study for the evaluation of acute elbow and forearm pain. CT Area of Interest With IV Contrast There is no evidence to support the use of contrast-enhanced CT of the elbow/proximal forearm as the initial imaging study for the evaluation of acute elbow and forearm pain. CT Area of Interest Without and With IV Contrast There is no evidence to support the use of noncontrast/contrast-enhanced CT of the elbow/proximal forearm as the initial imaging study for the evaluation of acute elbow and forearm pain. In the elbow, the additional knowledge gleaned from CT includes size of fracture fragments and amount of displacement or angulation, which may affect the surgical treatment options. Isolated radial head fractures, Essex- Lopresti injuries, and Monteggia fractures with dislocation of the elbow can be diagnosed. Traumatic elbow injuries are categorized into radial head fracture with posterior dislocation, terrible triad injury, posterior and anterior fracture-dislocation, trans-olecranon (anterior) fracture-dislocation, and varus posteromedial rotational instability. Fracture mapping and quantitative 3-D CT analysis of coronoid and olecranon fractures have identified specific shapes, sizes, and orientations of fracture fragments according to a pattern of traumatic elbow instability.