Why plan the elbow coronal to the epicondyles?

Angling perpendicular to the line joining the medial and lateral epicondyles gives a true anteroposterior view of the trochlea, capitellum and the collateral ligaments — so a ligament tear is shown along its length rather than cut obliquely.

Arm by the side or overhead for an elbow MRI?

Overhead ('superman') places the elbow nearer the magnet isocentre and gives more uniform fat suppression, but many patients cannot hold it still. By the side is more comfortable; if fat-sat then fails, STIR is the reliable fallback.

How does a UCL tear appear?

The ulnar collateral ligament becomes thickened and bright with fluid, or frankly discontinuous. Partial tears can show the 'tear-drop' or 'T-sign' of contrast/fluid tracking beneath the ligament's attachment.

Resources/Protocols

Elbow (UCL & tendons)

A hinge where the questions cluster around the collateral ligaments, the common flexor/extensor tendons and the ulnar nerve. Getting a true anteroposterior view of the joint — planned to the epicondyles — is what makes the ligaments assessable.

Protocols/Musculoskeletal

When this study is used

Ulnar collateral ligament injury ('Tommy John') — throwers and overhead athletes.
Medial or lateral epicondylitis (golfer's / tennis elbow).
Biceps or triceps tendon tear; ulnar-nerve symptoms (cubital tunnel).

Patient & coil positioning

Arm by the side if tolerated, or overhead ('superman') for isocentre — the superman position gives better fat suppression but is harder to hold still.
Elbow extended and supinated where possible; dedicated or flexible extremity coil centred on the joint space.
Pad and strap; small FOV and high matrix for the ligaments and nerve.

Localizer

Three-plane localizer covering the distal humerus to the proximal radius/ulna.

Sequence planning

Each sequence below lists how the slice group is positioned — the reference line it follows, its coverage, and why it earns its place in the protocol. Plan against the localizer, not by eye.

Coronal T2 / PD fat-sat

Coronal

Planning — Perpendicular to the line joining the medial and lateral epicondyles on the axial — a true AP view of the trochlea and capitellum.

Why — The ulnar and radial collateral ligaments and the common flexor/extensor origins; oedema of epicondylitis.

Axial T2 / PD fat-sat

Axial

Planning — Through the joint and cubital tunnel.

Why — Biceps and triceps tendons and the ulnar nerve in the cubital tunnel.

Sagittal T1 / T2

Sagittal

Planning — Through the joint.

Why — Distal biceps insertion, anterior/posterior anatomy, effusion.

Coronal STIR

Coronal

Planning — Matched coverage.

Why — Marrow oedema and ligament injury.

Representative parameters

Ranges, not commandments — field strength, coil and vendor move the numbers. What must not move is understanding why each sits where it does.

Sequence	Matrix / FOV	Notes
Coronal T2/PD FS	320–384 / 12–14 cm	UCL and common tendons
Axial T2/PD FS	320 / 12–14 cm	Ulnar nerve, biceps/triceps
STIR	256–320 / 12–14 cm	Marrow oedema

Artifacts & how to fix them

Artifact	Typical cause	Mitigation
Poor fat-sat	Elbow off isocentre by the side	Superman position; STIR or Dixon; re-shim
Motion blur	Uncomfortable overhead position	Pad and strap; parallel imaging to shorten
Magic angle	Curved tendon at 55°	Compare on T2 (long TE)
Metal blooming	Hardware	High bandwidth; spin echo over GRE

What am I looking at?

You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:

Finding	Sequence to check	How it reads
UCL tear	Coronal T2 FS	Thickened, high-signal or discontinuous ligament ('tear-drop' sign)
Epicondylitis	Coronal T2 FS	High signal in the common flexor/extensor origin
Ulnar neuritis	Axial T2 FS	Enlarged, bright ulnar nerve in the cubital tunnel

Review checklist

Coronal is a true AP view, perpendicular to the epicondylar line.
Ulnar nerve and cubital tunnel covered on the axial.
Fat suppression uniform (or STIR used) at the elbow's position.
Distal biceps insertion assessed on the sagittal.

Mistakes that cost repeats

An oblique coronal foreshortening the collateral ligaments.
Elbow off-centre by the side, so spectral fat-sat fails.
Motion from an unsustainable overhead position.
Missing the ulnar nerve by cropping the cubital tunnel.

Common questions

Why plan the elbow coronal to the epicondyles?: Angling perpendicular to the line joining the medial and lateral epicondyles gives a true anteroposterior view of the trochlea, capitellum and the collateral ligaments — so a ligament tear is shown along its length rather than cut obliquely.
Arm by the side or overhead for an elbow MRI?: Overhead ('superman') places the elbow nearer the magnet isocentre and gives more uniform fat suppression, but many patients cannot hold it still. By the side is more comfortable; if fat-sat then fails, STIR is the reliable fallback.
How does a UCL tear appear?: The ulnar collateral ligament becomes thickened and bright with fluid, or frankly discontinuous. Partial tears can show the 'tear-drop' or 'T-sign' of contrast/fluid tracking beneath the ligament's attachment.

Try it in ScanFlo: Plan the coronal perpendicular to the epicondylar line, then a straight coronal, and compare the UCL. The true-AP plane lays the ligament out; the oblique one foreshortens it — which is how a partial tear hides.

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