Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography

Abstract

Background: To investigate the role of shear wave elastography (SWE) in patients with lateral epicondylitis (LE) by assessing the common extensor tendon (CET) elasticity.Methods: A total of 62 unilateral LE patients were enrolled. Shear wave speed (SWS) and the thickness of CET in both elbows, along with the involved elbows with pre-and post-treatment, were obtained by SWE. The differences between groups, inter-and intra-observer agreements, and diagnostic accuracy were analyzed with a paired t-test, intraclass correlation coefficients (ICCs), and receiver operator characteristic (ROC) curve, respectively.Results: LE patients had significantly lower SWS on lesion sides compared to healthy elbows (P<0.05).The SWS of involved elbows were significantly higher after non-operation treatment than before treatment.The inter-and intra-observer agreements were excellent (ICCs: 0.900-0.993) for SWE measurements. Moreover, a 12.2 m/s cutoff value of mean SWS (C mean ) for discriminating LE patients from healthy subjects revealed a sensitivity and specificity of 93% and 93%, respectively.Conclusions: SWE is a valid imaging technique for the diagnosis of LE and monitoring of the treatment effect. Future studies are essential for investigating the correlations among clinical examinations, conventional ultrasound, and SWE.

Asymptomatic common extensor tendon pathology in patients with carpal tunnel syndrome

“…Conversely, stiffness of abnormal tendons is decreased 22 . The CET stiffness values obtained in our study are consistent with those of a previous study of lateral epicondylitis using the same ultrasound apparatus and methodology 23 . Tendon overuse is the main pathogenic mechanism in the onset of common extensor tendinopathy.…”

“…27 Accordingly, elastography has been suggested as a diagnostic tool for the evaluation of lateral epicondylitis. 23 However, our findings suggest that CET stiffness decreases in patients with CTS, even without symptomatic lateral epicondylitis, and thus should not be relied upon in isolation. Our study has several limitations.…”

“…Assessments of reliability of the ultrasound techniques was not performed, although these have been undertaken in other studies. 23 In conclusion, abnormalities of the CET as detected by ultrasound examination are common even in patients with no clinical evidence of lateral epicondylitis, especially in patients with clinical and EDx features of CTS. Our findings suggest that isolated ultrasound abnormalities in the CET are not diagnostically useful in patients presenting with an upper limb pain and sensory syndrome suggesting CTS unless there are clinical features to support an additional diagnosis of lateral epicondylitis.…”

“…22 The CET stiffness values obtained in our study are consistent with those of a previous study of lateral epicondylitis using the same ultrasound apparatus and methodology. 23 Tendon overuse is the main pathogenic mechanism in the onset of common extensor tendinopathy. Earlier work has shown that diseased tendons had decreased collagen fiber organization with increased tenocytes, fluid accumulation, vascularization, and fibroblasts, with no significant inflammatory response.…”

Elasticity of the coracohumeral ligament in patients with frozen shoulder following rotator interval injection: a case series

“…The ultrasound system propagates shear waves into tissues and assesses their elastic modulus. This has been used in a variety of musculoskeletal conditions including the rotator cuff tendons ( 16 , 17 ) , epicondylitis ( 18 ) , and Achilles ( 19 ) . Wu et al reported that in patients with clinical findings consistent with adhesive capsulitis shear wave elastography demonstrated that the CHL was significantly stiffer in the symptomatic shoulder compared with the asymptomatic shoulder ( 13 ) .…”