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Semin Musculoskelet Radiol 2024; 28(06): 683-693
DOI: 10.1055/s-0044-1791510
Review Article

Ultrasound of Lateral Epicondylitis

Franck Lapegue 
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
2   Clinique MEDIPOLE Garonne, Toulouse, France
3   ELSAN, Clinique Occitanie, Muret, France
,
Aymeric André
2   Clinique MEDIPOLE Garonne, Toulouse, France
4   Laboratoire d'anatomie, Faculté de Médecine de Toulouse, Toulouse, France
,
François Lafourcade
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Antoine Filiole
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Constance Lambeaux
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Viet-Tam Van
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Elorie Adamski
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Rafy Bachour
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Céline Goumarre
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Hélène Chiavassa
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Marie Faruch Bilfeld
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
,
Nicolas Sans
1   Service d'imagerie médicale, CHU de Toulouse-Purpan, Bâtiment Pierre Paul Riquet, Place du Docteur Baylac, Toulouse, France
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Abstract

Clinical findings are generally sufficient to make the diagnosis of lateral epicondylitis of the elbow. Ultrasound (US), in conjunction with standard radiography, is a simple and cost-effective way to confirm the diagnosis, and it is also useful for eliminating most differential diagnoses and guiding treatment.

US analysis of the muscle bodies and tendon laminae of the lateral epicondyle muscles, starting distally at the wrist and extending up to the lateral epicondyle, assists in understanding the complex fibrous architecture of the proximal tendons inserting on the lateral epicondyle. Pain when the US probe passes over an area of hypoechoic tendinosis, hyperemia in Doppler mode, and an intratendinous split are the signs to look for in patients. US helps guide needling or injection by targeting pathologic areas.

Other examinations (computed tomography arthrogram and magnetic resonance imaging) are used as a second line of defense, particularly in cases of bone or joint pathology.

Keywords

elbow - anatomy - ultrasound - tendon - lateral epicondylitis


Publication History

Article published online:
19 November 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med 2013; 126 (04) 357.e1-357.e6
    CrossrefPubMedSearch in Google Scholar
  • 2 Pasternack I, Tuovinen EM, Lohman M, Vehmas T, Malmivaara A. MR findings in humeral epicondylitis. A systematic review. Acta Radiol 2001; 42 (05) 434-440
    PubMedSearch in Google Scholar
  • 3 Maylack FH. Epidemiology of tennis, squash, and racquetball injuries. Clin Sports Med 1988; 7 (02) 233-243
    CrossrefPubMedSearch in Google Scholar
  • 4 Morris H. Lawn-tennis elbow. BMJ 1883; 2 (1185): 556-558
    PubMedSearch in Google Scholar
  • 5 Kamina P. Muscles de l'avant-bras. In: Kamina P. ed. Anatomie Clinique. Vol 1. Paris, France: Maloine; 2007: 224-239
    Search in Google Scholar
  • 6 Netter FH. Elbow and forearm. In: Netter FH. ed. Netter Atlas of Human Anatomy: Classic Regional Approach. 8th ed.. Philadelphia, PA: Elsevier; 2023. plates 446–461
    Search in Google Scholar
  • 7 Paulsen F, Waschke J. Upper extremity, muscle of the forearm. In: Paulsen F, Waschke J. eds. Sobotta Atlas of Human Anatomy with Latin Nomenclature. Vol 1. 15th ed.. Stuttgart, Germany: Urban and Fischer; 2011: 180-185
    Search in Google Scholar
  • 8 Omoumi P, Gondim Teixeira PA, Ward SR, Trudell D, Resnick D. Practical ultrasonographic technique to precisely identify and differentiate tendons and ligaments of the elbow at the level of the humeral epicondyles: anatomical study. Skeletal Radiol 2021; 50 (07) 1369-1377
    CrossrefPubMedSearch in Google Scholar
  • 9 Brasseur JL, Jacob D. Echographie de la face latérale du coude. In: Echographie du coude. Paris, France: Sauramps Medical; 2020: 89-120
    Search in Google Scholar
  • 10 Lapegue F, Andre A. Écho-anatomie des épicondyliens latéraux [in French] [Dissection and echoanatomy of the lateral epicondyle muscles]. YouTube video. 2023. Available at: https://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjCtuba1c6EAxV9TaQEHWx4CSE4ChC3AnoECAgQAg&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D0Lu25tP900g&usg=AOvVaw1_9BqPlHiBOI6iT-HTQGAy&opi=89978449 Accessed September 12, 2024
    PubMed
  • 11 Konarski W, Poboży T. A clinical overview of the natural course and management of lateral epicondylitis. Orthopedics 2023; 46 (04) e210-e218
    CrossrefPubMedSearch in Google Scholar
  • 12 Johns N, Shridhar V. Lateral epicondylitis: current concepts. Aust J Gen Pract 2020; 49 (11) 707-709
    CrossrefPubMedSearch in Google Scholar
  • 13 Yang X, Ying L, Ying L, Zhang Q, Han D, Zhou X. Modified arthroscopic tenotomy of the extensor carpi radialis brevis for refractory lateral epicondylitis: a cohort study. J Shoulder Elbow Surg 2024; 33 (03) 536-543
    CrossrefPubMedSearch in Google Scholar
  • 14 Dones III VC, Grimmer K, Thoirs K, Suarez CG, Luker J. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 2014; 14: 10
    CrossrefPubMedSearch in Google Scholar
  • 15 Krogh TP, Fredberg U, Ammitzbøl C, Ellingsen T. Ultrasonographic characteristics of the common extensor tendon of the elbow in asymptomatic individuals: thickness, color Doppler activity, and bony spurs. Orthop J Sports Med 2017; 5 (05) 2325967117704186
    CrossrefPubMedSearch in Google Scholar
  • 16 Ustabaşıoğlu F, Günay B, Samancı C, Emre Ustabaşıoğlu F. Assessment of common extensor tendon vascularization using superb microvascular imaging: a potential tool in the evaluation of extracorporeal shock wave therapy and therapeutic ultrasound effectiveness in lateral epicondylitis. Acta Radiol 2023; 64 (10) 2828-2835
    CrossrefPubMedSearch in Google Scholar
  • 17 Rupe MW, Fleury IG, Glass N, Kruse R, Buckwalter V JA. Efficacy of ultrasonic tenotomy and debridement and platelet-rich plasma injections for lateral elbow tendinopathy. J Hand Surg Glob Online 2023; 5 (05) 667-672
    CrossrefPubMedSearch in Google Scholar
  • 18 Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 2010; 30 (01) 167-184
    CrossrefPubMedSearch in Google Scholar
  • 19 Bonczar M, Ostrowski P, Dziedzic M. et al. Evaluation of lateral epicondylopathy, posterior interosseous nerve compression, and plica syndrome as co-existing causes of chronic tennis elbow. Int Orthop 2023; 47 (07) 1787-1795
    CrossrefPubMedSearch in Google Scholar
  • 20 Bal E, Cetin O. Demonstrating the relationship of ultrasonographic parameters with disease activity and pain in lateral epicondylitis. Medicine (Baltimore) 2023; 102 (40) e35499
    CrossrefPubMedSearch in Google Scholar
  • 21 Qi L, Zhang YD, Yu RB, Shi HB. Magnetic resonance imaging of patients with chronic lateral epicondylitis: is there a relationship between magnetic resonance imaging abnormalities of the common extensor tendon and the patient's clinical symptom?. Medicine (Baltimore) 2016; 95 (05) e2681
    CrossrefPubMedSearch in Google Scholar
  • 22 Ikeda K, Ogawa T, Ikumi A. et al. Individual evaluation of the common extensor tendon and lateral collateral ligament improves the severity diagnostic accuracy of magnetic resonance imaging for lateral epicondylitis. Diagnostics (Basel) 2022; 12 (08) 1871
    CrossrefPubMedSearch in Google Scholar
  • 23 Kessler RE, Day MS, Tyler TF. et al. Predictive value of magnetic resonance imaging in outcomes of nonsurgical treatment of lateral epicondylitis. JSES Int 2022; 6 (02) 305-308
    CrossrefPubMedSearch in Google Scholar
  • 24 Ang BFH, Mohan PC, Png MA. et al. Ultrasonic percutaneous tenotomy for recalcitrant lateral elbow tendinopathy: clinical and sonographic results at 90 months. Am J Sports Med 2021; 49 (07) 1854-1860
    CrossrefPubMedSearch in Google Scholar
  • 25 Suzuki T, Hayakawa K, Nakane T, Fujita N. Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis. J Shoulder Elbow Surg 2022; 31 (08) 1581-1587
    CrossrefPubMedSearch in Google Scholar
  • 26 Sharma GK, Patil A, Kaur P, Rajesh S, Drakonaki E, Botchu R. Comparison of efficacy of ultrasound-guided platelet rich plasma injection versus dry needling in lateral epicondylitis—a randomised controlled trial. J Ultrasound 2024; 27 (02) 315-321
    CrossrefPubMedSearch in Google Scholar
  • 27 Dakkak M, Patel V, King D, Genin J. Ultrasound-guided tenotomy for lateral epicondylitis with TenJet improves physical functional and decreased pain outcomes at 1 year: a case series review. JSES Int 2023; 7 (05) 872-876
    CrossrefPubMedSearch in Google Scholar
  • 28 Edelson G, Kunos CA, Vigder F, Obed E. Bony changes at the lateral epicondyle of possible significance in tennis elbow syndrome. J Shoulder Elbow Surg 2001; 10 (02) 158-163
    CrossrefPubMedSearch in Google Scholar