Ultrasound Clinical Case Study with Stephen Bird

Rheumatoid Elbow

Stephen Bird

Sonographer – Benson Radiology
AMS, AMS (Vascular), DMU, DMU (Vascular), MMedSon

A general sonographer with 25 years clinical experience, Stephen has a strong commitment to advancing ultrasound education. In 2002 Stephen received the ASA Pru Pratten Memorial Sonographer Achievement Award and in 2008 he was made an Honorary Fellow of ASUM.

Learn more about Stephen Bird's online courses and webinars.


Clinical diagnosis of synovial proliferative diseases is challenging because symptoms are often non-specific (1). Advanced imaging such as high-resolution ultrasound can aid in revealing characteristic findings of synovial proliferative diseases, which is key to an accurate diagnosis and for early treatment (2).

Synovial diseases can be inflammatory, infectious, neoplastic, degenerative, traumatic or haemorrhagic in nature (2). They can be a part of a systemic disease, such as (inflammatory) arthritis, or a primary process in a single joint. Bone erosions typically occur as part of a pathologic process involving the synovium and can result in irreversible joint destruction.

Articular bone erosions are now recognised as a central finding in rheumatoid arthritis and can be associated with poor functional outcomes (3). When synovial inflammation develops from autoimmunity, additional triggers augment the process of bone erosion.
The constellation of findings indicates synovial proliferative disease with associated bone erosions. This likely signifies rheumatoid disease and a rheumatological work up was recommended.


Advanced Dynamic Flow played a key role in many of the main findings of this case. Available on all Canon Medical Aplio ultrasound systems, ADF offers high-resolution colour flow that enables physicians to quickly identify small complex vascularity.

The Aplio a550 integrates industry-leading imaging technologies to deliver depth and detail to diagnose quickly with ease and confidence.


1. Synovial Tumors and Proliferative Diseases [Read here]

2. Basic radiological assessment of synovial diseases: a pictorial essay. 
Aynur Turan, Pınar Çeltikçi, Abdurrahman Tufan, and Mehmet Akif Öztürk [Read here]

3. Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment
Georg Schett and Ellen Gravallese [Read here]

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