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The sail sign on an elbow radiograph, also known as the anterior fat pad sign, describes the elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat. It indicates the presence of an elbow joint effusion.
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The posterior fat pad sign is the visualization of a lucent crescent of fat located in the olecranon fossa on a true lateral view of an elbow joint with the elbow flexed at a right angle indicating an elbow joint effusion. Normally, the posterior fat pad will not be seen in this view.
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Positive Posterior Fat Pad. A lateral radiograph of the elbow shows a crescentric lucency projecting posterior to the distal humerus (white arrow) representing fat which has been displaced by an elbow joint effusion. Such effusions are frequently secondary to trauma and a subtle fracture of the neck of the radius is present (red arrow).
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A visible anterior fat pad can be normal; it is a small radiolucent shadow adherent to the anterior aspect of the distal humerus: An abnormal anterior fat pad is described as a "sail sign" because it is unusually prominent and bows outward to form a triangular shape.
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Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head which is not visible directly). A normal anterior fat pad in a non-fractured arm.
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visible posterior fat pad always indicates an elbow effusion visible anterior fat pad may be seen in normal patients and should only be thought of as an indicator of an elbow effusion when massively raised if there is an effusion in an adult patient, think: acute intra-articular fracture and go looking for it
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Check for raised fat pads: visible posterior fat pad always indicates an elbow effusion visible anterior fat pad may be seen in normal patients and should only be thought of as an indicator of an elbow effusion when massively raised
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The fat pad sign is invaluable in assessing for the presence of an intra-articular fracture of the elbow. An anterior fat pad is often normal. However a posterior fat pad seen on a lateral x-ray of the elbow is always abnormal. The patient will be unable to flex their elbow and requires orthopaedic input.
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On a normal elbow x-ray, only a small stripe of an anterior fat pad should be visible. No posterior fat pad should be seen. Injuries around the joint can produce a joint effusion which will displace the fat pads making them more visible. The anterior fat pad protrudes more and looks pointy; this is what is recognized as the sail sign.
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AP and lateral x-ray of the elbow (really of the distal humerus) findings. posterior fat pad sign. lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow. measurement. displacement of the anterior humeral line.
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Normal elbow X-ray appearances On the lateral image there is often a visible triangle of low density lying anterior to the humerus. This is the anterior fat pad which lies within the elbow joint capsule. This is a normal structure.
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On the lateral x-ray of the elbow, a joint effusion can be inferred when there is displacement of the anterior fat-pad or presence of the posterior fat pad. An elbow joint effusion without a visible fracture seen on radiographs can suggest an occult fracture and should prompt further evaluation.
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On annotated image lateral view: Positive posterior fat pad sign as indicated by yellow line in the olecranon fossa. This is not seen on normal elbow radiographs. The positive sail sign is highlighted in red, the latter represents superior displacement of the anterior fat pad.
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The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus.
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Perform the elbow extension test. What are the X-ray Signs? The Fat Pad Sign. If you can see a fat pad, it simply indicates a joint effusion. You might normally see the anterior fat pad. However when it is so displaced by an effusion as to result in the 'sail sign' or when you see the posterior fat pad, it is a good marker for a fracture. CASE
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As previously mentioned, three intracapsular fat pads are present between the synovium of the elbow and the joint capsule. The anterior fat pad is a summation of the radial and coronoid fat pads, which are normally pressed into the shallow radial and coronoid fossae by the brachialis muscle during extension.
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A visible effusion (e.g. positive fat pad sign) on X-Ray indicates an injury around the elbow, and may be the only radiological evidence of a fracture. See Fat Pad Signs below. Elbow X-Rays in children can be difficult to interpret. A systematic approach should detect most elbow fractures.
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X-ray Elbow: Sail Sign. Abnormal fat pad: an elevated anterior fat pad or any visualized posterior fat pad is indicitive of an elbow injury. Sail sign: An elevated, sharply demarcated anterior fat pad. It is often the only radiographic signs for a radial head injury.
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The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus. This anatomic struc …
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Fat Pads of the Elbow. ... Sail sign - raised anterior fat pad due to effusion Occult fracture, usually of radial head; Fat Pads of the Knee. Look For ; The suprapatellar and prefemoral fat pads, normally next to each other on the lateral knee x-ray; Interpretation; Separation of fat pads - indicates joint effusion Ligamentous / menisceal ...
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