Nuclear medicine imaging of elbow and forearm injuries

Abstract

The elbow is a joint subject to significant mechanical stress. In general, injuries in sports medicine involving the elbow joint can be identified with a patient’s history and adequate physical examination. The role of nuclear medicine in elbow and forearm injuries is rather limited. A specific diagnosis can rarely be made on bone scintigraphy solely, mainly due to the complexity of the elbow joint, in which several structures overlap each other in a small area. Only in very specific diagnoses, including (stress) fractures, lateral and medial epicondylalgia, osteochondritis dissecans, and (a)septic loosening of prosthetic implants, nuclear medicine is able to play an additional role in imaging the elbow. A threephase bone scintigraphy, using a technetium-99m (99mTc)-labeled diphosphonate complex, is the cornerstone within nuclear medicine imaging and can detect fractures, prosthesis loosening, and inflammation. The exact role of bone scintigraphy in loosening of elbow prostheses is still a matter of debate. For imaging infections after elbow arthroplasty, leukocyte scintigraphy in combination with three-phase bone scintigraphy is the nuclear imaging method of choice. However, anti-granulocyte monoclonal antibody imaging has shown good results in elbow prostheses and may be considered to be an adequate alternative in institutions without of the opportunity to label leukocytes ex vivo. This chapter highlights the role of nuclear medicine in injuries of the elbow and the forearm.