Lateral epicondylitis : evaluation by using high resolution ultrasonography

Abstract EN

Our study shows the usefulness of sonography of the lateral epicondylitis Patients: Sixty-eight consecutive patients with lateral elbow pain were selected for this study from the Rheumatology Outpatient Clinic at Dr.

Erfan General Hospital, Kingdom of Saudi Arabia over one year.

They were 45 men and 23 women with a mean age of 45.6 years (age range 21-67 years).

Fifty-four patients provided a history of repetitive injury from tennis (n=27), lifting (n=14), using a tool (n=7), typing (n=3), or other sports (n=3).

Fourteen patients could not state any obvious cause of their injury.

The initial diagnosis was made based on history and clinical findings.

Exclusion criteria for this study were acute trauma and previous surgical intervention.

Some patients had a "blind" injection of steroid but not within 21 days before imaging.

We excluded seven patients who had received a steroid injection in the 3 weeks before sonography.

Methodology: Patients were examined with a 10-MHz hockey-stick probe (HDI 5000; ATL, Bothell, WA).

The examination included comprehensive imaging of the four muscles that make up the common extensor origin, the radial collateral ligament , and the posterior interosseous nerve.

The examination time was approximately 15 min.

Correlation was made with the opposite elbow in all patients.

The size of the tendon was examined relative to the normal elbow.

Results: The most common sonographic appearance was a focal hypoechoic area on either a normal background or one characterized by a diffuse decrease in echo texture with loss of the normal fibrillar pattern.

The size of the focal hypoechoic areas ranged from three to 15 mm (mean, 8.7 mm).This finding occurred in 43 of 68 elbows and was believed to represent focal areas of fibroblastic degeneration in a normal tendon or in one with underlying diffuse tendinopathy.

Nineteen of the 68 elbows underwent surgery, and the sonographic findings were confirmed in all patients.

At surgery, the common extensor origin was split in the line of its fibers from the tip of the epicondyle distally.

This split revealed the deep portion of the origin.

Surgical findings of lateral epicondylitis included a macroscopically amorphous gray tissue, a partially shredded tendon containing a space that was not separated or retracted, and a fluid-filled defect with smooth edges that was contiguous with joint fluid.

Conclusion: Sonography of the common extensor origin can confirm the clinical suspicion of lateral epicondylitis and exclude other causes of lateral elbow pain.

Sonography can provide useful information about the location, extent, and severity of lateral epicondylitis before surgery.