Elbow - Anterior View

Anterior humeral recess

Ultrasound Images

Main Image

Main image - Case GM-ANT-N-A1128

Annotations

Comparison image - Case GM-ANT-N-A1128

Classification

Case code: GM-ANT-N-A1128
Joint: Elbow
View: Anterior
Severity: Normal

Patient

Age: 46 years
Sex: Female
Condition: Healthy control subject
Joint ROM: Extension 0°, Flexion 145° (normal)
Additional image 1 - Case GM-ANT-N-A1128
Additional image 2 - Case GM-ANT-N-A1128
Additional image 3 - Case GM-ANT-N-A1128

History

Healthy adult female with no history of joint diseases, bleeding disorders, or significant elbow trauma. Works as administrative professional with moderate computer use but no repetitive strain symptoms. Recreational activities include yoga (3 times weekly) and hiking on weekends. No previous elbow injuries, surgeries, or chronic pain. Non-smoker, minimal alcohol consumption. BMI 22.8 (normal range). No current medications except occasional multivitamin. No family history of bleeding disorders or arthropathies. Presents as healthy control volunteer for ultrasound reference database study establishing normal parameters for elbow anterior compartment structures in middle-aged female adults. Reports no current complaints related to either elbow and maintains full functional capacity in all activities of daily living and recreational pursuits.

Physical Examination

Elbow appears entirely normal on inspection with symmetric appearance bilaterally. No swelling, erythema, ecchymosis, or visible deformity. Normal carrying angle (approximately 15° valgus, physiological for female). Palpation reveals no tenderness, effusion, synovial thickening, or bony prominences. Full active and passive range of motion: extension 0° (no hyperextension), flexion 145°, supination 85°, pronation 80° - all values within normal limits for age and sex. No pain or crepitus throughout range of motion. Muscle strength testing shows 5/5 throughout (biceps, triceps, brachioradialis, wrist flexors/extensors). No evidence of cubital tunnel syndrome: Tinel's sign negative at ulnar groove, elbow flexion test negative. No lateral or medial epicondyle tenderness. Ligamentous stability testing normal with no valgus or varus laxity. Neurovascular examination intact with normal radial pulse and sensation throughout all dermatomes. Able to perform full functional tasks including lifting, carrying, pushing, and pulling without discomfort.

Ultrasound Findings

Ultrasound examination in anterior view demonstrates normal anatomy:

  • Anterior joint capsule: thin (<2mm), homogeneous appearance
  • Anterior recess: collapsed, no effusion
  • Coronoid fossa: normal depth and contour
  • Radial head: smooth cartilaginous surface
  • Capitellum: regular articular surface
  • Bony surfaces: sharp cortical margins, no osteophytes
  • Brachialis muscle: normal echostructure
  • Biceps tendon: normal size and structure
  • No fluid collection or inflammatory signs
  • No synovial thickening or hyperemia

Anatomical Zones

Anterior humeral recess

The anterior recess of the elbow joint demonstrates completely normal anatomical features typical of a healthy middle-aged female adult with no history of joint pathology or trauma.
Synovial thickness and joint space: <1mm (normal, barely perceptible)
Findings: The anterior recess of the elbow joint appears as a narrow potential space anterior to the distal humerus, best visualized between the coronoid and radial fossae. The synovial membrane is barely perceptible, measuring less than 1mm in thickness, appearing as a thin hypoechoic line closely approximated to the underlying bone and overlying anterior joint capsule. The recess is completely collapsed with no evidence of joint effusion - the capsule lies in direct contact with the humeral fossae. The coronoid fossa demonstrates normal depth and smooth contour with sharp, well-defined bony margins appearing as a hyperechoic concave surface with characteristic posterior acoustic shadowing. The radial fossa, located lateral to the coronoid fossa, shows similar normal anatomy with appropriate depth to accommodate the radial head during flexion. The articular cartilage covering the trochlea and capitellum appears as a thin, uniform hypoechoic band (approximately 1-1.5mm thick) overlying the hyperechoic subchondral bone, with perfectly smooth and regular surface contour. No hyperechoic debris, loose bodies, or internal echoes are visible within the joint space. The anterior fat pad (anterior to the capsule) demonstrates normal hyperechoic adipose tissue appearance without displacement, thickening, or inflammatory changes. The posterior fat pad is not visible in this anterior view, which is normal - its visualization would indicate joint effusion. The brachialis muscle, which lies immediately anterior to the anterior capsule and serves as an important sonographic landmark, shows normal pennate muscle architecture with homogeneous medium-level echogenicity and preserved muscle fibers oriented obliquely toward the coronoid process. No intramuscular edema, hematoma, or tears are evident. The distal biceps tendon, visible in the medial portion of the anterior view as it courses toward its insertion on the radial tuberosity, demonstrates normal fibrillar echostructure with parallel hyperechoic lines representing collagen bundles, normal thickness (approximately 5-6mm at the myotendinous junction), and sharp margins. Color and Power Doppler examination reveals complete absence of intra-articular or synovial vascularity - no flow signals detected anywhere in the anterior recess or synovium, confirming absence of inflammatory activity. The overlying soft tissues including subcutaneous fat and skin appear normal with preserved tissue planes and no edema. Dynamic examination during passive elbow flexion and extension demonstrates normal opening and closing of the anterior recess. During extension, the coronoid process of the ulna moves posteriorly out of the coronoid fossa, and the recess becomes maximally visible though remains collapsed without pathological distension. During flexion, the coronoid enters the fossa and the radial head enters the radial fossa, with smooth articulation and no evidence of impingement, synovial hypertrophy, or loose bodies restricting motion. The capsule shows normal distensibility and elasticity throughout range of motion without redundancy, thickening, or adhesions.
Anterior humeral recess
Anterior humeral recess

Direct Comparison

Compare this case with reference cases of different severity grades for in-depth analysis.

Cases available for comparison: 3 of 3 possible

Additional Notes

This case serves as a normal control reference for the ultrasound atlas, documenting typical anterior elbow anatomy in a healthy 46-year-old female. All measured parameters fall within established normal ranges for age and sex. The complete absence of synovial proliferation, cartilage irregularities, bony changes, or inflammatory signs provides ideal baseline comparison for pathological cases. This subject represents an optimal control given the preservation of joint health despite age and regular upper extremity use in daily activities. The case emphasizes the importance of establishing age-appropriate and sex-specific normal reference values, as subtle differences exist between male and female anatomy (carrying angle, bone dimensions) and between age groups. Minor physiological variations related to aging (very subtle cartilage changes, minimal joint space variation) must be distinguished from pathological alterations. This normal reference is particularly valuable for comparative studies in hemophilic arthropathy, where ultrasound assessment aims to detect early subclinical joint changes before clinical manifestations appear. The elbow is commonly affected in hemophilia as a target joint, making normal reference cases essential for educational purposes. The documentation serves to train clinicians in identifying normal ultrasound anatomy before recognizing pathological deviations, establishing the baseline from which disease progression can be measured.