CT Arthrography Elbow There is limited evidence to support the routine use of CT arthrography elbow for nerve abnormalities at the elbow following radiographs. CT Elbow CT axial images in flexion and extension can demonstrate recurrent ulnar nerve dislocation because of a snapping of the medial head of the triceps [47]. MR Arthrography Elbow There is limited evidence to support the routine use of MR arthrography elbow for nerve abnormalities following radiographs. MRI Elbow T2-weighted MR neurography is the reference standard for imaging ulnar nerve entrapment (UNE) [48-50]. Most common findings include high signal intensity and nerve enlargement [50]. Diagnostic confidence can be increased with the use of diffusion-tensor imaging [49,51]. Diffusion-tensor imaging and tractography also provide quantitative information in 3-D perspective [47,49]. However, 3T MRI has only fair-to-moderate agreement for localization of compression points in UNE [52,53]. Radial nerve, median nerve, and other entrapment syndromes can also be evaluated with MRI [54,55]. US Elbow US elbow is another option for evaluation of UNE. Assessment of cross-sectional area/nerve thickness has high accuracy rates [48,56-58]. US also accurately demonstrates hourglass constriction of the nerve [59]. Dynamic US is helpful in demonstrating nerve dislocation in ulnar nerve neuropathy and snapping triceps syndrome [59-62]. Shear-wave elastography is a newer method used for the diagnosis of ulnar neuropathy at the elbow. Values of 100% specificity, sensitivity, and both positive and negative predictive value have been reported [63,64]. Chronic Elbow Pain Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac.
Chronic Elbow Pain. CT Arthrography Elbow There is limited evidence to support the routine use of CT arthrography elbow for nerve abnormalities at the elbow following radiographs. CT Elbow CT axial images in flexion and extension can demonstrate recurrent ulnar nerve dislocation because of a snapping of the medial head of the triceps [47]. MR Arthrography Elbow There is limited evidence to support the routine use of MR arthrography elbow for nerve abnormalities following radiographs. MRI Elbow T2-weighted MR neurography is the reference standard for imaging ulnar nerve entrapment (UNE) [48-50]. Most common findings include high signal intensity and nerve enlargement [50]. Diagnostic confidence can be increased with the use of diffusion-tensor imaging [49,51]. Diffusion-tensor imaging and tractography also provide quantitative information in 3-D perspective [47,49]. However, 3T MRI has only fair-to-moderate agreement for localization of compression points in UNE [52,53]. Radial nerve, median nerve, and other entrapment syndromes can also be evaluated with MRI [54,55]. US Elbow US elbow is another option for evaluation of UNE. Assessment of cross-sectional area/nerve thickness has high accuracy rates [48,56-58]. US also accurately demonstrates hourglass constriction of the nerve [59]. Dynamic US is helpful in demonstrating nerve dislocation in ulnar nerve neuropathy and snapping triceps syndrome [59-62]. Shear-wave elastography is a newer method used for the diagnosis of ulnar neuropathy at the elbow. Values of 100% specificity, sensitivity, and both positive and negative predictive value have been reported [63,64]. Chronic Elbow Pain Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac.