Background Lateral epicondylitis (LE) is a common non-traumatic condition. The diagnosis of LE is typically made clinically. Some lateral epicondylitis patients can profit from supplementary imaging for a precise differential diagnosis. Recently, shear wave elastography has been increasingly attracting public attention in evaluation of tendon pathology and tissue elasticity quantitatively. The purpose of our study was to prove that shear wave elastography can be utilized in the diagnosis and follow-up of lateral epicondylitis. Results This cross-sectional analytic study involved 42 patients with unilateral lateral epicondylitis (30 males, 12 females with age range: 30–50 years, mean age: 39.9 ± 6 SD). The patients were reviewed by two radiologists with experience of more than 10 years, blinded to each other's results. Lateral epicnodylitis was diagnosed based on clinical criteria. The thickness of common extensor tendon and shear wave speed (SWS) were acquired in elbows bilaterally, along with values of the involved elbows in pre- and post-treatment phases. The comparison between examined groups, inter-rater and intra-rater concordance, and the diagnostic performance have been investigated with paired t-test, an intraclass correlation coefficients (ICCs), and a receiver operator characteristic curve, respectively. The patients with lateral epicondylitis showed a significantly decreased value of shear wave speed on affected side in comparison to the healthy side (P value: 0.000). The shear wave speed of diseased elbows has increased significantly following non-operative management than before therapy. The inter-rater and intra-rater concordance showed both excellent values (ICCs ranged from 0.939 to 1.000) for shear wave speed measurements. Furthermore, a 10.72 m/s cutoff limit of mean SWS (shear wave speed) for differentiating lateral epicondylitis elbows from healthy elbows showed a sensitivity and specificity of 90.5% for both. Conclusions Shear wave elastography can be of value as a technique with proper reproducibility and proper diagnostic performance for evaluation and monitoring the therapeutic effect in patients with lateral epicondylitis.
Background Adhesive capsulitis of the shoulder is a pain syndrome of progressive nature, associated with reduced active and passive range of motion of the gleno-humeral joint. Previous studies suggested an underlying synovial inflammatory process, followed by capsular hypertrophy and reactive fibrosis. The aim of our study was to investigate the influence of anterior shoulder joint capsule abnormal thickening and abnormal signal intensity on MRI, as important imaging biomarkers, for the diagnosis of as adhesive capsulitis. Results This cross sectional analytic study involved 28 patients with adhesive capsulitis ((17 males, 11 females, age range:23–65 years, mean age: 45.61 years ± 11.95) and 28 controls (14 males, 14 females; age range, 39 to 61 years; mean age 52.82 years ± 6.45;). The patients and the controls were reviewed by two radiologists with experience of more than 10 years, blinded to each other's results. Adhesive capsulitis was diagnosed based on clinical criteria of significant restricted passive motion of shoulder joint. The thickness and abnormal signal intensity of anterior glenohumeral joint capsule were evaluated at its thickest portion, positioned underneath the subscapularis muscle. Additionally, the formerly known MR characteristics of adhesive capsulitis, involving the thickness of humeral and glenoid portions of axillary recess, maximal thickness of axillary capsule, and thickness of coracohumeral ligament, were assessed. The estimation of abnormal hyperintensity of humeral and glenoid capsule in axillary recess, subcoracoid fat triangle obliteration and abnormal hyperintensity were also included in our study. All magnetic resonance imaging (MRI) quantitative values showed significant difference between adhesive capsulitis group and control group. Regarding qualitative values, only abnormal high signal intensity of the anterior portion of joint capsule, of the axillary portion of joint capsule and of glenoid portion of axillary capsule showed statisticaly significant difference between cases and controls. In receiver operating characteristic (ROC) curve study, the anterior capsule thickness revealed a high diagnostic value with an area under the curve (AUC) of 1.0. An anterior capsule thickness cut off value of at 2.45 mm showed a very high diagnostic performance, revealing a sensitivity of and specificity of 100%. Conclusions The anterior glenohumeral joint capsule abnormal thickening, and abnormal hyperintensity have a high diagnostic performance, in addition to the previously known abnormal MRI findings, in the evaluation of adhesive capsulitis.
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