No abstract

Introduction: The literature suggests that abnormal sonographic findings of the common extensor origin (hypoechogenicity, neovascularity, calcifications, irregular margin, presence of adjacent fluid, irregular fibrillar pattern, thickness, tear) and of the lateral epicondyle (cortical irregularities) can be used to confirm the presence of Lateral Epicondylalgia (LE) in elbows which have been initially diagnosed using the clinical diagnosis for LE. The association of these abnormal sonographic findings and the initial clinical diagnosis for LE were studied. Methodology: The participants were recruited in Metro Manila (Philippines) through advertisements and referral by doctors and physiotherapists. LE was determined if participants reported lateral elbow pain on one elbow which was replicated by any of the Cozen’s, Mill’s, or Maudsley’s tests. Acuity of elbow symptoms was determined using six weeks since symptom onset as the time differentiating acute from chronic LE. A prospective blinded sonographic assessment of both elbows of participants was performed using a valid and reliable scanning protocol. Results: Fifty-one participants provided 55 symptomatic and 46 asymptomatic elbows (one elbow ineligible due to congenital shortening). Duration of elbow pain ranged from a day (acute) to 36 months (chronic). The hypoechogenicity of the common extensor origin was moderately associated with acute LE (sensitivity=67%, specificity=38%) and strongly associated with chronic LE (sensitivity=81%, specificity=64%). The calcifications of the CEO were found to be significantly associated with acute LE (DOR: 14.62) and chronic LE (DOR: 7.26) with p<0.05. Conclusion: Sonographic measures of hypoechogenicity and calcifications of the common extensor origin may complement the findings from the elbow provocation tests in confirming a diagnosis of acute or chronic LE.

Introduction: The literature reports an increase in anteroposterior diameter of the common extensor origin (CEO) of the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) or the radial nerve in painful elbows diagnosed with lateral epicondylalgia (LE) or supinator syndrome. The edge-to-edge measurements of these anatomical structures are quantified using musculoskeletal ultrasound (MSUS). However, in the current literature, reports on the reliability and validity of MSUS measurements of the CEO (of ECRB and EDC) and the radial nerve are not found. In this study, reliability was measured for three testers in determining the anteroposterior diameter of the CEO (of ECRB and EDC) and the radial nerve. Moreover, the concurrent validity was determined of MSUS measurements with Vernier calipre measurements using formalin preserved elbows of human cadavers. Methodology: Cadaver measurements of the CEO (of ECRB and EDC) and the radial nerve were performed. Initially, the sonologist measured the anteroposterior diameter of the CEO (of ECRB and EDC) and the radial nerve. A month after scan, the formalin preserved cadavers were dissected. Consequently, the anteroposterior diameter of the exposed CEO (of ECRB and EDC) and the radial nerve was measured using the Vernier calipre. Results: Eight upper extremities of four embalmed Filipino cadavers (2 males: 2 females) were dissected. A total of seven (7) CEO of EDC, seven (7) CEO of ECRB, and eight (8) radial nerves at the level of the radial head in the elbows of four (4) cadavers were measured using the MSUS and the Vernier calipre. The MSUS and Vernier calipre protocol used in this study was found to be reliable, p > 0.05. However, in all three levels of interest, the MSUS measurements were statistically different from the Vernier calipre measurements, p < 0.05. Conclusion: MSUS and Vernier calipre measurements are reliable methods in measuring the CEO (of ECRB and EDC) and the radial nerve. While each of these methods is reliable in measuring the anteroposterior dimensions of the CEO (of the EDC and ECRB) and the radial nerve, substituting one for the other yielded statistically different measurement results.

Objective: To evaluate relative and absolute reliability and repeatability in assessing median nerve mobility at the level of the wrist and distal upper arm of the right upper extremity during wrist extension. Methods: Six healthy participants participated in the study. Median nerve mobility was captured three times at both sites using Sonocyte Turbo by two sonologists for a total of 72 video clips (36 for each site and 18 by each sonologist). Longitudinal movement was measured using Motion Tracking Analysis Program (MTAP) by the two assessors who were rehabilitation medicine residents. After one month, the assessors remeasured the longitudinal excursion of the median nerve of the previous video clips. Results: There was moderate agreement between the two sonologists of the median nerve mobility at the level of the distal upper arm and the wrist respectively. There was a moderate to almost perfect agreement between the two assessors’ readings in the mobility of the nerve at level of the distal upper arm and wrist for the first and second readings. Repeatability testing showed that there was variable agreement at the level of the distal upper arm and at the wrist. Conclusion: MTAP using fast template tracking with an adaptive template is a reliable tool that can be employed in the accurate assessment of median nerve mobility at the distal upper arm and wrist.