Diagnostic Value of Musculoskeletal Ultrasound in Acute and Chronic Lateral Epicondylalgia

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.