Ultrasonographic Assessment of Tendon Thickness, Doppler Activity and Bony Spurs of the Elbow in Patients with Lateral Epicondylitis and Healthy Subjects: A Reliability and Agreement Study

Abstract

Purpose: Tennis elbow, also known as lateral epicondylitis (LE), is a common disorder often assessed by ultrasound. The aim of this study was to evaluate the ultrasonographic outcomes and methods used in LE research and clinical practice.

Materials and Methods: This study was designed as an intra- and interobserver reliability and agreement study. Ultrasonographic examination of the common extensor tendon of the elbow was performed. The intraobserver study examined tendon thickness twice in 20 right elbows from 20 healthy individuals at an interval of 7 to 12 days. The interobserver study examined tendon thickness, color Doppler activity, and bony spurs in 18 right elbows in 9 healthy individuals and 9 patients with LE. Two trained rheumatologists performed the interobserver examinations with the same scanner on the same day. The main outcomes were intra- and interclass correlation (ICC) and agreement.

Results: In the intraobserver study, the ICC with regard to tendon thickness ranged from 0.76 to 0.81, depending on the measurement techniques used. The agreement ranged from 0.06 to 0.13 mm. In the interobserver study, the tendon thickness ICC ranged from 0.45 to 0.65 and the agreement ranged from –0.17 to 0.13 mm. The ICC for color Doppler activity was 0.93, with agreement in 14/18 (78 %) of the cases. A perfect reliability was demonstrated for bony spurs, with an ICC of 1 and exact agreement in 18/18 (100 %) of the cases.

Conclusion: Good to excellent reliability was obtained for all measurements. The ultrasonographic techniques evaluated in this trial can be recommended for use in both research and clinical practice.

Zusammenfassung

Ziel: Der Tennisellbogen, auch bekannt als Epicondylitis lateralis humeri (LE) ist eine häufige, oftmals sonografisch bewertete Erkrankung. Das Ziel dieser Studie war die Einschätzung der sonografischen Ergebnisse und der Methoden, die in der LE-Forschung und klinischen Praxis Anwendung finden.

Material und Methoden: Diese Studie wurde als Intra- und Interobserver-Übereinstimmungsstudie konzipiert. Es wurde eine sonografische Untersuchung der gemeinsamen Strecksehne des Ellbogens durchgeführt. In der Intraobserver-Studie wurde zweimal die Sehnendicke in 20 rechten Ellbogen von 20 Gesunden in einem Abstand von 7 bis 12 Tagen bestimmt. Die Interobserver-Studie untersuchte Sehnendicke, Farbdoppleraktivität und Knochensporne in 18 rechten Ellbogen von 9 Gesunden und 9 Patienten mit LE. Zwei ausgebildete Rheumatologen führten die Interobserver-Untersuchungen mit demselben Gerät am gleichen Tag durch. Als Hauptresultate wurden die Intra- und Interklasse-Korrelationen (ICC) sowie die Übereinstimmung erhoben.

Ergebnisse: In der Intraobserver-Studie erstreckte sich der ICC in Bezug auf die Sehnendicke, je nach verwendeter Messtechnik, von 0,76 bis 0,81. Die Übereinstimmung lag zwischen 0,06 und 0,13 mm. In der Interobserver-Studie erstreckte sich der ICC der Sehnendicke von 0,45 bis 0,65, die Übereinstimmung lag zwischen –0,17 und 0,13 mm. Der ICC für die Doppler-Aktivität betrug 0,93 mit einer Übereinstimmung in 14/18 Fällen (78 %). Eine ausgezeichnete Übereinstimmung wurde für Knochensporne gezeigt, mit einem ICC von 1 und einer exakten Übereinstimmung (100 %) in 18/18 Fällen.

Schlussfolgerung: In allen Messungen wurde eine gute bis ausgezeichnete Übereinstimmung erzielt. Die in dieser Studie bewerteten sonografischen Techniken können sowohl für die Forschung als auch für die klinische Praxis empfohlen werden.

Key words

tendons - elbow - soft tissues - ultrasound - ultrasound color Doppler

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