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Elbow X-ray (2 views, both sides)

A child's elbow is the hardest joint in the body to read on an x-ray, because much of it is still cartilage and the bony centers appear at different ages. That is why the uninjured elbow is often filmed alongside the injured one — it provides the normal to compare against. This listing is the two-view elbow study done on both arms.

This explanation has not been reviewed by a person yet.

What it is

The elbow is where three bones meet, and in a growing child several parts of those bones have not yet turned to bone at all. They appear on x-ray one at a time over childhood, in a sequence, and a center that has not arrived yet simply is not visible. The result is that a perfectly normal child's elbow can look alarming and a genuinely broken one can look normal. The standard answer to that problem is to film both elbows: whatever is present on one side should be present, in the same place and the same shape, on the other. Anything that differs is the injury. The two views in this study are the front and the side — the arm laid straight on the plate for one, bent to a right angle and rolled onto its edge for the other.

Why it is done

  • To identify a fracture around the elbow after a fall onto an outstretched arm, the commonest mechanism in children
  • To provide a matched image of the uninjured elbow for comparison, so that normal growth centers are not mistaken for damage
  • To check whether the joint is dislocated or the bones have shifted out of their normal relationship
  • To confirm that alignment has held during treatment in a cast or after a repair
  • To assess long-standing elbow pain in adults for arthritis, old injury, or fragments loose in the joint

What to expect

For the straight view the arm lies flat on the plate with the palm up; for the side view the elbow is bent and the arm is turned onto its edge, which is the part that hurts on a fresh injury. A technologist positions the arm, steps behind a screen, and repeats for the other side if comparison films are being taken. The whole visit is usually under ten minutes. There is no preparation and no after-effect. In a child with a painful elbow, positioning is done gently and with support; sedation is not normally involved. A radiologist issues the formal reading.

Questions worth asking

  • If the uninjured elbow was filmed only for comparison, does it appear as a second billed study, and did anyone say so beforehand?
  • Do comparison views of a normal limb get covered by my plan, given there is no symptom on that side?
  • Is a children's emergency department pricing this differently from a general one or from an orthopaedic office?
  • If the child is sent on to a pediatric orthopaedic surgeon, will that office reuse these images or take their own?
  • Is the radiologist's over-read billed on top of the emergency physician's own look at the films?

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