Comparison of sonography and MRI for diagnosing epicondylitis

Miller, Theodore T.; Shapiro, M A; Schultz, Elizabeth; Kalish, Paul E.

doi:10.1002/jcu.10063

Cited by 177 publications

(95 citation statements)

References 9 publications

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“…Since 1990, when the first sonographic changes were described that could be linked to lateral epicondylopathy, 7 several studies have been performed in symptomatic populations to assess, among other aspects, structural changes to the CET and their corresponding sonographic manifestations, although with widely differing results. 3,[8][9][10] We are of the opinion that in most cases, lateral epicondylopathy is a progressive clinical process resulting in progressive and sequential sonographic changes. We also believe that some of the sonographic alterations thought to be associated with the disease could appear in those who have never had it.…”

mentioning

confidence: 99%

Sonographic Findings for the Common Extensor Tendon of the Elbow in the General Population

Jaén-Díaz¹,

Cerezo-López²,

Castro

et al. 2010

Journal of Ultrasound in Medicine

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Objective. To describe structural characteristics and sonographic alterations of the common extensor tendon (CET). Methods. In 240 patients, we determined the body mass index; sonographic CET thickness, morphologic characteristics, and alterations; and color Doppler measurements of the epicondylar artery width and peak systolic velocity. Age, sex, epicondylalgia history, activities (work, sports, and hobbies), and dominant and nondominant elbows were noted. . Thickness correlated weakly with age (dominant, r = 0.284; nondominant, r = 0.215) and moderately with weight (dominant, r = 0.492; nondominant, r = 0.502). The mean epicondylar artery diameter was 1.35 mm (SD, 0.96 mm); mean peak velocity, 13.01 cm/s (SD, 4.90 cm/s). Morphologic abnormalities were found in 79.5% of patients with a history of epicondylalgia; 7.7% with no history had abnormalities; and 55.9% with abnormalities but no history were older than 55 years. Bone spurs (49.2% versus 16.4% [P < .001]), tendon calcifications (21.5% versus 3.9% [P < .001]), and bone cortex abnormalities (12.3% versus 1.7% [P < .001]) were found more often in non-normal elbows; 79.4% of bone spurs in normal elbows occurred in patients older than 55 years. Conclusions. Mild sonographic alterations in the CET and bone spurs should be considered with caution when assessing epicondylar pain, especially in patients older than 55 years and those with a history of epicondylalgia.

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confidence: 99%

Sonographic Findings for the Common Extensor Tendon of the Elbow in the General Population

Jaén-Díaz¹,

Cerezo-López²,

Castro

et al. 2010

Journal of Ultrasound in Medicine

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“…Sonographic features of rheumatoid epicondylitis include outward bowing of the common flexor tendon, presence of hypoechoic fluid adjacent to the common tendon, tendon thickening, decreased echogenicity, and common tendons with illdefined margins. These features are non-specific and were reported in several studies [21].…”

Section: Discussionmentioning

confidence: 86%

Ultrasound assessment of elbow enthesitis in patients with seronegative arthropathies

et al. 2013

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Background Enthesopathy is an evolving area for applied clinical research. MRI is the gold standard in the diagnosis of elbow joint pathology, but recent reports indicate that ultrasound imaging is more sensitive and accurate than MRI in detecting enthesopathy of the heels and knees. Too many patients are under-diagnosed and/or misdiagnosed because the early pathological changes of enthesitis in the different types of seronegative arthropathies are not detected. Objectives This study was undertaken to describe the ultrasound features of elbow enthesitis in patients with seronegative arthropathies. Methods We studied 38 diseased elbows in 38 patients with spondyloarthropathies (26 men and 12 women, mean age 32 years). All had elbow enthesopathy without typical conventional radiographic findings. Patients with histories of degenerative changes and/or local steroid injections were excluded. An HDI 3000 ATL ultrasound machine was used with a 5-12 MHz linear transducer to examine the affected elbow joints. The elbows of 10 normal healthy individuals were examined as normal controls.The patients were examined in the supine position with the elbow flexed 30°-50°. Longitudinal and transverse scans were obtained of the radiohumeral joint, the ulnahumeral joint, and the olecranon fossa. Two independent observers unaware of the clinical diagnosis read the ultrasound images and assessed the collateral ligaments, intratendinous echogenicity, tendon calcification, tendon thickness, presence of fluid, synovial proliferation, and bony changes. The reliability of the sonographic images was assessed by review of video recordings of the ultrasound examinations. Results Ultrasound revealed loss of the fibrillar echopattern (100 %), lack of a homogenous pattern with loss of the tightly packed echogenic dots (100 %), peritendinous edema with flaring of the tendon margins (84.2 %), irregular fusiform tendon thickening (100 %), and hyperechoic intratendinous lesions with ill-defined focal defects (18.4 %). Ultrasound also detected intratendinous calcifications of both the common extensor and common flexor tendons (52.6 %). Bony erosions were seen at the tendon insertions into the lateral epicondyles (13.15 %). Conclusion Ultrasonographic features of elbow enthesitis differed from those described in knee and heel enthesitis. Ultrasound clearly showed early signs of tendon calcification, tendon edema, peritendinitis, and bony entheseal erosions. However, in elbow enthesitis the early bone erosion was associated with bone marrow edema, and the common extensor tendon was diffusely thickened. Ultrasound is a reliable, reproducible bedside imaging procedure. It improves the documentation of disease activity, progression, and treatment responses in patients with spondyloarthropathies. We recommend its use for the diagnosis and post-treatment follow-up of patients with enthesitis and seronegative spondyloarthropathies.

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“…Studies demonstrating pathological changes in common extensor tendon, ulnar collateral ligament or heel tendon have been reported [10][11][12][13][14] . However, there were limited studies investigating the role of ultrasonography in lateral epicondylitis [1,4,10,12] .…”

Section: Ultramentioning

confidence: 99%

“…However, there were limited studies investigating the role of ultrasonography in lateral epicondylitis [1,4,10,12] . To our knowledge, this is the first study investigating the correlation of ultrasonographic findings with duration of symptoms and severity of pain.…”

Section: Ultramentioning

confidence: 99%

An overview of ultrasonography in lateral epicondylitis: Correlation with disease duration and severity

Boy

Özkan

Külcü

et al. 2015

IJDI

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The purpose of this study is to make an overview for ultrasonographic features of lateral epicondylitis and to investigate the correlation of these features with clinical findings including disease duration and severity. This prospective study included 42 consecutive patients diagnosed with lateral epicondylitis on clinical examination. Three patients had bilateral involvement, therefore, 45 elbows were examined with ultrasonography. In addition, the asymptomatic contralateral 39 elbows of 39 patients and as a control group, 16 elbows of 16 healthy asymptomatic volunteers were examined. The ultrasonographic features of lateral epicondylitis in common extensor tendon including focal hypoechoic area, heterogenicity, focal areas of calcification, increase or decrease in thickness, partial or complete tear, peritendinous fluid collection and entesophyte were investigated. These findings were compared with the clinical findings including the duration and severity of complaint. Visual analog scale (VAS) was used to evaluate the severity of pain. Fisher exact test and Mann-Whitney U test were used in statistical analysis, and all tests were considered significant at p < .05 in 95% CIs. In the diseased elbows, the most common finding of the lateral epicondylitis was heterogenicity, focal hypoechoic area and entesophyte, respectively. Statistical examination revealed no significant correlation between ultrasonographic findings and duration of the symtoms. There was also no significant correlation between ultrasonographic findings and severity of pain. Ultrasonography can demonstrate well the features of lateral epicondylitis. It could also be helpful to show the extent of the disease. However, ultrasonographic findings do not significantly correlate with duration and severity of the disease clinically.

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Comparison of sonography and MRI for diagnosing epicondylitis

Cited by 177 publications

References 9 publications

Sonographic Findings for the Common Extensor Tendon of the Elbow in the General Population

Sonographic Findings for the Common Extensor Tendon of the Elbow in the General Population

Ultrasound assessment of elbow enthesitis in patients with seronegative arthropathies

An overview of ultrasonography in lateral epicondylitis: Correlation with disease duration and severity

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