Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis

Bachta, Artur; Rowicki, Krzysztof; Kisiel, Bartłomiej; Żabicka, Magdalena; Elert-Kopeć, Sylwia; Płomiński, Janusz; Tłustochowicz, Witold; Maliborski, Artur

doi:10.1371/journal.pone.0181828

Cited by 30 publications

(22 citation statements)

References 13 publications

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“…US examination results were not compared with magnetic resonance imaging (MRI) findings, and although the sensitivity and specificity of US have been shown to be comparable to that of MRI, it is often felt that MRI should be used to confirm US findings. 1,5,10,12 Thus, the US findings of this study should be interpreted with some reservation, until confirmed with MRI and/or clinical findings. In contrast to previous studies, concerning asymptomatic tendinopathy, participants in this study were recruited after presenting to a foot and ankle clinic.…”

Section: Discussionmentioning

confidence: 74%

Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

et al. 2020

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Background: Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs. Methods: Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy. Results: Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants. Conclusion: Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 74%

Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

et al. 2020

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“…The diagnosis of LE is based primarily on clinical examination, like visual analogy scale (VAS), and often confirmed with diagnostic imaging including conventional ultrasound (US), magnetic resonance imaging (MRI), real-time sonoelastography, etc. for cases of atypical presentation or those resistant to conservative treatment (6,7). Furthermore, imaging techniques provide the information related to the physiopathology of disease condition and determine the radiological severity of LE, and can be essential in assessing the level of impairment, planning treatment strategies, or guiding surgery (5,8,9).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, imaging techniques provide the information related to the physiopathology of disease condition and determine the radiological severity of LE, and can be essential in assessing the level of impairment, planning treatment strategies, or guiding surgery (5,8,9). Although MRI has been widely considered as a reliable complementary method for LE assessment, the high cost, lengthy examination time, and several contraindications may limit its widespread use (6). Currently, the US is increasingly playing a vital role in the diagnosis of LE with inexpensive, non-invasive, and dynamic features.…”

Section: Introductionmentioning

confidence: 99%

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

Zhu¹,

You²,

Xiang³

et al. 2020

Quant Imaging Med Surg

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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.

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“…Ultrasonography (US) has a sensitivity of 64.52%, speci city of 85.19%, and an accuracy of 72.73% in comparison to Magnetic resonance (MRI) [28]. MRI is the gold standard for diagnostic imaging of LE, associated lesions, and for excluding differential diagnoses, but its cost is still high compared to other methods.…”

Section: Discussionmentioning

confidence: 99%

“…MRI is the gold standard for diagnostic imaging of LE, associated lesions, and for excluding differential diagnoses, but its cost is still high compared to other methods. Its use is relevant, especially in refractory cases, and when it is desired to have a better assessment of the extent of the lesion in the common extensor tendon origin and associated lesion [28].…”

Section: Discussionmentioning

confidence: 99%

How One Treats Lateral Epicondylitis - A Survey Among Brazilian Orthopedists

Lazarini

Zan

Belotti

et al. 2021

Preprint

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Background: Lateral epicondylitis (LE) or tennis elbow is the most common elbow painful condition. It affects around 1 to 3% of adults. There are various possibilities of treatment described in the literature, without evidence to support a gold standard management protocol. Therefore, the objective of this study is to evaluate how the Brazilian orthopedist diagnoses and treats lateral epicondylitis, to compare these results with the available evidence. Methods: This is an observational, analytical, cross-sectional study. A questionnaire has been prepared for information to the participants and with eight specific questions (2 on diagnosis and 6 on treatment). These had been answered voluntarily by participants at 3 major congresses of orthopedists in Brazil in 2018. The results were analyzed in accordance with the overall number of responses, and were evaluated among groups according to subspecialty. Results: We obtained a total of 501 questionnaires. Of these, 33 were excluded. The mean age was 38.67 years. The majority of respondents (91%) were male. We obtained 26.7% from specialists in hand surgery (Hand group), 36.5% from subspecialists in shoulder and elbow (Shoulder and Elbow group), and 36.8% were from generalists in orthopedics or from other subspecialties (General Orthopedists group). For diagnosis, 24.4% have not initially requested any imaging method. The most requested exam was ultrasonography (54.9%). The most prominent indication for initial treatment was physical therapy. For refractory cases, 78.3% of the respondents prefer doing a local infiltration. The most commonly used substance for local infiltrations is corticosteroids (89.6%). With respect to the surgical treatment option, 75.8% of those who recommend it prefer open techniques and 24.2% arthroscopic treatment. Of the total respondents, 12.8% do not recommend surgical treatment for LE. Conclusion: Most orthopedists begin the treatment of lateral epicondylitis with the use of non-steroidal anti-inflammatory drugs, physical therapy, and an indication of rest, but there is great variability between their recommendations. The use of corticosteroids for infiltration remains the main choice among Brazilian orthopedists, although evidence shows a better effect in the short term and a worse effect in the medium and long term, compared to other treatments.

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Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis

Cited by 30 publications

References 13 publications

Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

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

How One Treats Lateral Epicondylitis - A Survey Among Brazilian Orthopedists

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