Tennis elbow: an ultrasonographic study in tennis players.

Abstract

The findings of ultrasound examination at and around the lateral humeral epicondyle in 41 tennis players suffering from so called tennis elbow are reported. Ultrasound examinations were performed with a real time ultrasound machine. The tenderness and functional impairment of tennis elbow may be caused by several different lesions, at times appearing in association. Six ultrasonographic characteristics could be identified:Enthesiopathy The proximal part of the tendon was enlarged and there were echogenicity alterations. Tendonitis The tendon of the extensor carpi radialis brevis was enlarged and areas of dyshomogeneous hypoechogenicity were evident with loss of the normal microscopic waveform structure of the tendon collagen.Peritendonitis A thickening of the peritendonous lining was present. Bursitis A bursa was located on the inferior surface of the tendon of the extensor carpi radialis brevis. Intramuscular haematoma Some circular or ovoid hypoechogenic areas within the muscular substance of the extensor carpi radialis brevis were evident. Mixed lesions These were not correlated with the intensity and the duration of the symptoms.Ultrasonographic examination gives a detailed iamge of the structures involved in the tennis elbow syndrome, confirms the diagnosis, and may be useful in monitoring treatment.

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

“…Alternatively, they may have been of similar severity from the outset. Previous studies 3,7,10 involving sonography of pathologic tendons in patients with tennis elbow differed widely with regard to the alterations detected, which makes the comparison with our findings more difficult and means that neither of the two possibilities proposed above can be definitively ruled out. Therefore, we believe that further studies are required to shed more light on this issue.…”

“…5 Numerous physiopathologic, diagnostic, and therapeutic aspects of this condition are currently under investigation, 6 and the role of sonography in the management of this problem remains unclear. 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.…”

Comparison of sonography and MRI for diagnosing epicondylitis

“…8 Microcalcifications, which may be present in cases of chronic tendinosis, were not visualized in any of the cases, but our study did not include low-kilovoltage radiography to determine whether microcalcifications were present.…”

“…Investigators have studied the relationships among the findings of MRI, surgery, and histopathologic examination in patients with epicondylitis 3,5 and have described the various characteristics of this condition on both MRI scans 5,6 and sonograms 7,8 but have not compared the accuracy of the 2 modalities. We sought to determine whether sonography is a reasonable alternative to MRI for the diagnosis of epicondylitis by comparing the sensitivity and specificity of both modalities.…”

Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

“…Originally, an inflammatory process was thought to be the cause of lateral epicondylitis [10]. Various authors have attributed the cause to other conditions including bursitis [21], synovitis [20], and degenerative arthritis [28]. In addition, the extensor carpi radialis brevis (ECRB) origin is the commonly noted source of disease [10,29].…”