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

Abstract

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.

Prevalence and Risk Factors of Lateral Epicondylitis in a Mountain Village in Japan

“…5,13 However, the common extensor tendon is thicker in patients with a history of epicondylalgia, and its size is associated with the patient's weight. 22 Smoking may interfere with circulation to tendons by slowing their healing and thus may result in lateral epicondylitis. 13 However, another study reported no such association.…”

The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review

“…Considering the term ‘Lateral epicondylalgia’ is irrelevant to the nature, acuity and sources of pathology of lateral elbow symptoms [9], the name ‘Lateral epicondylalgia’ encompasses lateral epicondylitis [10], lateral elbow tendinosis [11], lateral elbow enthesopathy [12,13], or lateral elbow epicondylopathy [14]. …”

Towards an understanding of motor system impairments in individuals with unilateral lateral epicondylalgia

“…Despite using MSUS imaging to assess for changes within the tendon in all participants in Chapters 8 and 9, we decided not to include the results of the MSUS examination as part of the inclusion criteria but include participants into the study based on the results of a clinical diagnosis using a standardised clinical examination, in line with previous major randomised controlled trials (Bisset et al, 2006a;Coombes, Bisset, Brooks, Khan, & Vicenzino, 2013). Although MSUS imaging identifies the presence or absence of greyscale features and neovascularisation within the tendon, results of Study 3 (see Chapter 7) and evidence from others has shown a high percentage of individuals with no history of pain, trauma, or treatment have tendon changes visible with MSUS imaging (Cook et al, 1998;Fredberg & Bolvig, 2002;Giombini et al, 2013;Heales et al, 2014a;Jaén-Díaz et al, 2010;Ustuner et al, 2013). Finally, due to the case-control study design implemented within this thesis it is not possible to determine whether differences in the motor system are associated with the cause or as a consequence of LE.…”

“…Tendon pathology of the common extensor origin in 12 to 13% of asymptomatic individuals has been validated with musculoskeletal ultrasound imaging, and this is greater in the dominant arm and with increasing age (Jaén-Díaz et al, 2010;Ustuner, Toprak, Baskan, & Oztuna, 2013). Jaén-Díaz and colleagues (Jaén-Díaz et al, 2010) revealed that 85% of individuals with asymptomatic tendon pathology were older than 40 years of age. In the current study 29 (91%) of the 32 pain-free controls were 40 or more years of age, which might explain the high proportion of tendon abnormality.…”

“…Data from the asymptomatic side will likely aid in the understanding of the systemic involvement of the central and peripheral motor systems, but cannot be considered to be a reference for "normal" function, thus the inclusion of a pain-free control is recommended. Third, a high prevalence of structural changes within the tendons of asymptomatic individuals (using MSUS examination) identified within Study 3 (see Chapter 7), and previous work (Jaén-Díaz et al, 2010;Ustuner et al, 2013), complicates the view of what is considered "normal" tendon structure. The inclusion of participants based only on the structural pathology within the tendon will likely limit the generalisability of future research.…”