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A Guide to Imaging for Elbow Osteoarthritis

elbow arthritis elbow imaging elbow osteoarthritis elbow radiographs elbow x-rays osteoarthritis
A Guide to Imaging for Elbow Osteoarthritis

A Systematic Guide to Reading Elbow Osteoarthritis Radiographs

Essential Views

Start with standard anteroposterior (AP) and lateral views of the elbow joint. For complex cases, oblique views can provide additional insights.

Joint Space Assessment

Joint space narrowing is a key indicator of osteoarthritis, predominantly affecting the radiocapitellar joint (58%) and less commonly the ulnotrochlear joint (16%). Look for characteristic nonuniform narrowing patterns throughout the joint spaces.

Osteophyte Formation

Osteophytes, or bony outgrowths, are hallmark features that appear as irregular projections at joint margins. They most commonly develop at the:

  • Olecranon (96% of cases)
  • Coronoid process (90%)
  • Radial head (86%)
  • Coronoid and radial fossae (64%)

Subchondral Bone Changes

Examine the bone beneath the cartilage for two key changes:

  • Subchondral sclerosis: Areas of increased bone density
  • Subchondral cysts: Appearing as radiolucent regions surrounded by sclerotic borders

Additional Features

  1. Loose Bodies: Search for calcified fragments within the joint space
  2. Soft Tissue Changes: Note any swelling or effusion, particularly in advanced cases
  3. Joint Alignment: Verify proper alignment, as subluxations may occur in severe cases
  4. Comparative Analysis: When possible, compare with the contralateral elbow or reference images

Advanced Stage Indicators

In progressed cases, expect to find:

  • Significant radiocapitellar joint narrowing
  • Prominent osteophyte formation on the olecranon and coronoid processes
  • Marked subchondral sclerosis at the ulnohumeral joint
  • Visible intra-articular loose bodies

This systematic approach enables accurate assessment of elbow osteoarthritis severity through radiographic examination.



  1. Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007;15 Suppl A:A1-56. doi: 10.1016/j.joca.2006.11.009. PMID: 17320422.
  2. Dalal S, Bull M, Stanley D. Radiographic changes at the elbow in primary osteoarthritis: a comparison with normal aging of the elbow joint. J Shoulder Elbow Surg. 2007 May-Jun;16(3):358-61. doi: 10.1016/j.jse.2006.08.005. Epub 2006 Dec 22. PMID: 17188910.
  3. Alnusif NS, Matache BA, AlQahtani SM, Isa D, Athwal GS, King GJW, MacDermid JC, Faber KJ. Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis. J Shoulder Elbow Surg. 2021 Jul;30(7S):S8-S13. doi: 10.1016/j.jse.2021.04.001. Epub 2021 Apr 20. PMID: 33892121.
  4. Kwak JM, Kholinne E, Sun Y, Alhazmi AM, Koh KH, Jeon IH. Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment. Osteoarthritis Cartilage. 2019 Jul;27(7):1057-1063. doi: 10.1016/j.joca.2019.03.004. Epub 2019 Mar 25. PMID: 30922981.
  5. Amini MH, Sykes JB, Olson ST, et al. Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow. J Shoulder Elbow Surg. 2015;24(3):353-357. doi:10.1016/j.jse.2014.10.015

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