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Xrays are done predominantly for fractures and other red flag conditions, and are not helpful for conditions such as tendinopathies.
Rules for imaging in the trauma setting
- Significant force applied to the elbow
- Immediate loss of elbow function
- Marked soft tissue swelling / contusion
- Bony tenderness with no other diagnosis, as a screen for intra-osseous pathology
- Compression of the joint reproduces pain – as a screen for intra-articular pathology
- Instability shown on examination (varus / valgus aligned stress testing)
- Risk factors for osteoporosis or pathological fractures (Paget’s)
- In the presence of abnormal movements of the elbow (instability / locking)