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Cocco G, Ricci V, Corvino A, Abate M, Vaccaro A, Bernabei C, Cantisani V, Vallone G, Caiazzo C, Caulo M, Pizzi AD. Musculoskeletal disorders in padel: from biomechanics to sonography. J Ultrasound 2024; 27:335-354. [PMID: 38578364 PMCID: PMC11178742 DOI: 10.1007/s40477-023-00869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024] Open
Abstract
Padel is a racket sport, combining high-frequency and low-intensity athletic gestures, that has been gaining growing scientific interest in recent years. Musculoskeletal injuries are very common among padel players with an incidence rate of 3 per 1000 h of training and 8 per 1000 matches. To the best of our knowledge, a comprehensive collection describing the most common sonographic findings in padel players with musculoskeletal injuries is lacking in the pertinent literature. In this sense, starting from the biomechanical features of padel-specific gestures we have reported the ultrasonographic patterns of most frequent injuries involving the upper limb, the trunk, and the lower limb. Indeed, comprehensive knowledge of the biomechanical and clinical features of musculoskeletal injuries in padel is paramount to accurately perform a detailed ultrasound examination of the affected anatomical site. So, the present investigation aims to provide a practical guide, simple and ready-to-use in daily practice, to optimize the sonographic assessment of padel players by combining it with the clinical findings and the biomechanical features of athletic gestures.
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Affiliation(s)
- Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, 6610, Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
| | - Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy.
| | - Michele Abate
- IRCSS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Adele Vaccaro
- Department of Radiology, SS. Annunziata Hospital of Chieti, University "G. D'Annunzio", Chieti, Italy
| | - Carlotta Bernabei
- Department of Radiology, SS. Annunziata Hospital of Chieti, University "G. D'Annunzio", Chieti, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology, Sapienza-University of Rome, Anatomo-Pathology, Rome, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, 6610, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University "G. D'Annunzio", Chieti, Italy
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Marotta N, de Sire A, Lippi L, Moggio L, Mondardini P, Sgro M, Bartalotta I, Zito R, Giroldini T, Invernizzi M, Longo UG, Ammendolia A. Effectiveness of High-Power Laser Therapy via Shear Wave Speed Analysis on Pain and Functioning in Patients with Lateral Epicondylitis: A Proof-of-Concept Study. J Clin Med 2024; 13:2014. [PMID: 38610779 PMCID: PMC11012724 DOI: 10.3390/jcm13072014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Lateral epicondylitis (LE) causes lateral elbow pain due to the overuse of the common extensor tendon. Several therapies have been proposed for pain relief and functional recovery, including physical therapy, minimally invasive injection approaches, and physical agent modalities such as laser therapy. Methods: Our study evaluates the impact of high-power laser therapy (HPLT) on pain and functioning. The HPLT protocol consists of 10 daily sessions using a LASERIX PRO device. The healthy elbow of each participant was also considered as a control group. The outcomes assessed were the Numerical Rating Scale (NRS) for pain, QuickDASH questionnaire for functionality, and shear wave velocity (SWS) through ultrasonography. Assessments were conducted at baseline (T0), post-treatment (T1), and 2-week follow-up (T2). Results: Sixteen participants (81.2% male, mean age 40.4 ± 5.53 years) completed the study. Post-treatment, pain significantly decreased (NRS: T0 6.13 ± 0.96; T1 2.75 ± 1.69; p < 0.001), functionality improved (QuickDASH: T0 69.88 ± 10.75; T1 41.20 ± 3.78; p < 0.001), and shear wave velocity increased (SWS (m/s): T0 1.69 ± 0.35; T1 2.56 ± 0.36; p < 0.001). Conclusions: At the 2-week follow-up, pain relief was maintained, and shear wave velocity showed no further significant change. Shear wave velocity assessments might be considered a useful diagnostic tool. However, further research is needed to support the role of HPLT and shear wave velocity in the rehabilitation management of LE.
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Affiliation(s)
- Nicola Marotta
- Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, 1085 Budapest, Hungary;
| | - Lucrezia Moggio
- Rehabilitation Unit, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Paolo Mondardini
- Department of Sport Science, Università di Bologna, 40100 Bologna, Italy
| | - Maria Sgro
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Isabella Bartalotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Roberta Zito
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Teobaldo Giroldini
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy;
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
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Keijsers R, Kuijer PPFM, Gerritsma-Bleeker CLE, Kleinlugtenbelt YV, Beumer A, The B, Landman EBM, de Vries AJ, Eygendaal D. In the Treatment of Lateral Epicondylitis by Percutaneous Perforation, Injectables Have No Added Value. Clin Orthop Relat Res 2024; 482:325-336. [PMID: 37594385 PMCID: PMC10776141 DOI: 10.1097/corr.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND No single injection therapy has been proven to be superior in the treatment of lateral epicondylitis. In most studies, the injection technique is not standardized, which makes it challenging to compare outcomes. QUESTIONS/PURPOSES (1) Does injection with autologous blood, dextrose, or needle perforation only at the extensor carpi radialis brevis tendon origin produce better VAS pain scores during provocation testing at 5 months of follow-up? (2) Which percutaneous technique resulted in better secondary outcome measures: VAS during rest and activity, VAS during maximum grip, Oxford elbow score (OES), QuickDASH, Patient-related Tennis Elbow Evaluation (PRTEE), or EuroQol-5D (EQ-5D)? METHODS In this multicenter, randomized controlled trial performed from November 2015 to January 2020, 166 patients with lateral epicondylitis were included and assigned to one of the three treatment groups: autologous blood, dextrose, or perforation only. Complete follow-up data were available for the primary outcome measures at the 5-month follow-up interval for 77% (127 of 166) of patients. Injections of the extensor carpi radialis brevis tendon were conducted in an accurate and standardized way. The three groups did not differ in terms of key variables such as age, gender, duration of symptoms, smoking habits, pain medication, and physiotherapy use. Data were collected at baseline and 8 weeks, 5 months, and 1 year after treatment and compared among the groups. The primary endpoint was the VAS pain score with provocation at 5 months. Our secondary study outcomes were VAS pain scores during rest, after activity, and after maximum grip strength; functional recovery; and quality of life. Therefore, we report the VAS pain score (0 to 100, with higher scores representing more-severe pain, minimum clinically important difference [MCID] 10), OES (0 to 48, with higher scores representing more satisfactory joint function, MCID 10), QuickDASH (0 to 100, with higher scores representing more severe disability, MCID 5.3), PRTEE (0 to 100, with higher scores representing more pain or more disability, MCID 20), EQ-5D/QALY (EQ-5D sumscore 0 to 1, with the maximum score of 1 representing the best health state, MCID 0.04), and EQ-5D VAS (0 to 100, with higher scores representing the best health status, MCID 8). For analysis, one-way analysis of variance and a linear mixed-model analysis were used. The analyses were performed according to the intention-to-treat principle. Four patients from the perforation group opted to crossover to autologous blood after 5 months. RESULTS No injection therapy proved to be superior to any other in terms of VAS pain scores during the provocation test at 5 months of follow-up (VAS for perforation: 25 ± 31; autologous blood: 26 ± 27; dextrose: 29 ± 32; p = 0.35). For the secondary outcomes, only a clinically important difference was found for the QuickDASH score. Both the perforation-only group (-8 [98% CI -4 to -12]) and autologous blood (-7 points [98% CI -3 to -11]) had improved QuickDASH scores over time compared with the dextrose group (MCID 5.3; p < 0.01). For the other outcomes, no clinically important differences were found. CONCLUSION There is no benefit to injectable autologous blood and dextrose over perforation alone to treat lateral epicondylitis, and they are therefore not indicated for this condition. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
| | | | | | | | - Annechien Beumer
- Amphia, Orthopedics, Breda, the Netherlands
- Amsterdam UMC, Public and Occupational Health, Amsterdam, the Netherlands
| | | | | | | | - Denise Eygendaal
- Erasmus Medical Center, Orthopedics and Sports Medicine, Rotterdam, the Netherlands
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Cancela-Cilleruelo I, Rodríguez-Jiménez J, Fernández-de-las-Peñas C, Cleland JA, Arias-Buría JL. Pressure Pain Hypersensitivity and Ultrasound Changes in the Radial Nerve in Patients with Unilateral Lateral Epicondylalgia: A Case-Control Study. Diagnostics (Basel) 2023; 13:2488. [PMID: 37568851 PMCID: PMC10417200 DOI: 10.3390/diagnostics13152488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Some authors have proposed the potential role of the radial nerve in lateral epicondylalgia. The aims of this study were to investigate the presence of pressure pain hyperalgesia and nerve swelling (increased cross-sectional area) assessed with ultrasound imaging on the radial nerve in people with lateral epicondylalgia, and to investigate if an association exists between pressure pain sensitivity and cross-sectional area. A total of 37 patients with lateral epicondylalgia (43% women, age: 45.5 ± 9.5 years) and 37 age- and sex-matched pain-free controls were recruited for participation. Pressure pain thresholds (PPTs) were assessed bilaterally on the radial nerve at the spiral groove, the arcade of Frohse, and the anatomic snuffbox in a blinded design. Further, the cross-sectional area of the radial nerve at the spiral groove and antecubital fossa was also assessed. The results demonstrated lower PPTs on the radial nerve of the affected side in individuals with lateral epicondylalgia as compared with the unaffected side (p < 0.01) and with both sides in healthy controls (p < 0.001). Additionally, the cross-sectional area of the radial nerve on the affected side in patients was higher compared with the unaffected side (p < 0.01) and both sides in healthy controls (p < 0.001). The cross-sectional area of the radial nerve at the spiral groove was negatively associated with PPTs over the radial nerve at the spiral groove (r = -0.496, p = 0.002) and positively associated with function (r = 0.325, p = 0.045). Our findings revealed generalized pressure pain hyperalgesia and also nerve swelling of the radial nerve in people with lateral epicondylalgia, suggesting the presence of a widespread sensitization of nerve tissues in this population. The radial nerve could represent a potential peripheral drive to initial and maintain altered pain processing in lateral epicondylalgia.
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Affiliation(s)
- Ignacio Cancela-Cilleruelo
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (J.R.-J.); (J.L.A.-B.)
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (J.R.-J.); (J.L.A.-B.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (J.R.-J.); (J.L.A.-B.)
| | - Joshua A. Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA;
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain; (J.R.-J.); (J.L.A.-B.)
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Hong S, Hahn S, Yi J, Park EJ, Bang JY. Comparing the clinical application of strain elastography and shear wave elastography for the evaluation of lateral epicondylitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:123-130. [PMID: 36169174 DOI: 10.1002/jcu.23356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to compare the diagnostic performance of gray-scale ultrasound (GSU), strain elastography (SE), and shear wave elastography (SWE) for lateral epicondylitis (LE). METHODS From November 2018 to March 2021, 87 common extensor tendons (CETs) of 70 patients were evaluated using elbow ultrasound. Patients were divided into two groups: patients with LE and those without lateral elbow pain. GSU, SE, and SWE findings from the two groups were compared, and the diagnostic performance was compared for significant variables. RESULTS Among the 70 patients, 41 with 44 CETs were clinically diagnosed with LE, and 29 with 43 CETs had no lateral elbow pain. Hypoechogenicity, calcification, and hyperemia were significantly different. Strain ratio (SR), stiffness, and shear wave velocity (SWV) were also significantly different. The diagnostic accuracy of stiffness and SWV was better than that of other significant findings. Furthermore, there were no superiorities in SR, stiffness, or SWV. CONCLUSION Both SE and SWE can be valuable diagnostic tools for diagnosing LE. The diagnostic performances of both SE and SWE were similar in the detection of LE.
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Affiliation(s)
- Sujin Hong
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Eun Joo Park
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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García-Martínez J, Miguel-Pérez M, Pérez-Bellmunt A, Ortiz-Miguel S, Viscor G. The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157733. [PMID: 34360027 PMCID: PMC8345749 DOI: 10.3390/ijerph18157733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022]
Abstract
The course of the posterior antebrachial cutaneous nerve (PACN) was studied via ultrasound (US) and dissection. The aim of this study was to reveal the anatomical relationships of PACN with the surrounding structures along its pathway to identify possible critical points of compression. Nineteen cryopreserved cadaver body donor upper extremities were explored via US and further dissected. During US exploration, two reference points, in relation with the compression of the nerve, were marked using dye injection: (1) the point where the RN pierces the lateral intermuscular septum (LIMS) and (2) the point where the PACN pierces the deep fascia. Anatomical measurements referred to the lateral epicondyle (LE) were taken at these two points. Dissection confirmed the correct site of US-guided dye injection at 100% of points where the RN crossed the LIMS (10.5 cm from the LE) and was correctly injected at 74% of points where the PACN pierce the deep fascia (7.4 cm from the LE). There were variations in the course of the PACN, but it always divided from the RN as an only branch. Either ran close and parallel to the LIMS until the RN crossed the LIMS (84%) or clearly separated from the RN, 1 cm before it crossed the LIMS (16%). In 21% of cases, the PACN crossed the LIMS with the RN, while in the rest of the cases it always followed in the posterior compartment. A close relationship between PACN and LIMS, as well as triceps brachii muscle and deep fascia was observed. The US and anatomical study showed that the course of PACN maintains a close relationship with the LIMS and other connective tissues (such as the fascia and subcutaneous tissue) to be present in its pathology and treatment.
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Affiliation(s)
- Jose García-Martínez
- Horta Osteopathic Clinic, 08031 Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain;
- Correspondence: (J.G.-M.); (M.M.-P.)
| | - Maribel Miguel-Pérez
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain;
- Correspondence: (J.G.-M.); (M.M.-P.)
| | - Albert Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain;
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Sara Ortiz-Miguel
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain;
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain;
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain;
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Intractable lateral epicondilytis: A differential diagnosis algorithm for a correct clinical interpretation. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094877. [PMID: 34063673 PMCID: PMC8125558 DOI: 10.3390/ijerph18094877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim was to analyze effects of a percutaneous neuromodulation (PNM) treatment on the radial nerve, regarding pain, functionality, electrophysiologic excitability, and morphology, in patients with chronic lateral epicondylalgia (LE). METHODS Twenty-four patients with chronic unilateral elbow pain were recruited for this preliminary study and were divided into two groups: control (n = 12) and PNM group (n = 12). The subjects in the PNM group received percutaneous peripheral neurostimulation with an acupuncture needle that was located next to the nerve with ultrasound guidance. Pain using a numerical rating scale (NRS), functional ability using patient-rated tennis elbow evaluation (PRTEE), radial nerve cross-sectional area measured by ultrasound, and chronaxie and accommodation index (AI) measured by the strength-duration curve were evaluated. RESULTS Both groups showed no differences in the baseline measurements (all p = 0.001). However, at the end of the treatment, there were significant differences between groups since only the PNM group significantly improved their values compared to their baseline values: level of pain and cross-sectional area (CSA) values showed a significant decrease while the PRTEE scores showed a significant improvement. Then, regarding AI, the PNM group showed significant improvement for the electrophysiologic nerve excitability pattern, reporting normal function in all radial nerves after treatment (p = 0.001). However, chronaxie values always reported similar values with no differences between groups (p >0.05); Conclusion: Ultrasound-PNM technique may be an interesting therapeutic tool for the treatment of chronic LE due to the improvement in the level of pain, functionality, nerve morphology, and excitability in this population.
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Lateral ulnar collateral ligament (LUCL) reconstruction for the treatment of recalcitrant lateral epicondylitis of the elbow: a comparison with open débridement of the extensor origin. JSES Int 2021; 5:578-587. [PMID: 34136874 PMCID: PMC8178594 DOI: 10.1016/j.jseint.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Based on the controversy over whether the extensor tendon is the only lesion of lateral epicondylitis of the elbow and numerous reports of concomitant lateral collateral ligament involvement, potential damage to the lateral collateral ligament complex should be considered for the treatment. Methods About 25 elbows in 23 patients (débridement group) and 22 elbows in 20 patients (reconstruction group) who were diagnosed with lateral epicondylitis and had an average of 22 months of symptoms revealing anatomical lesion on MRI were included. The capitellum-sublime tubercle-radial head (CSR) angle was measured on both sides preoperatively, and the visual analog scale (VAS) and Mayo elbow performance score (MEPS) were measured over 12 months, postoperatively. Results The initial preoperative mean VAS was statistically significant with 4.6 in the débridement group and 6.5 in the reconstruction group (P < .05). Postoperative VAS was continuously decreased in both groups with no significant difference at each assessment period (P < .05) but showed more rapid improvement in the reconstruction group compared with the débridement group. For MEPS, the reconstruction group showed significant improvement during the follow-up periods, and at the final follow-up MEPS, 3 cases in the débridement group and 0 cases in the reconstruction group showed a poor result, which was considered as surgery failure. The CSR angle of the affected side (7.2 ± 1.9) was significantly larger than that of the normal side (3.6 ± 1.5) (P < .05) in the reconstruction group. Increased CSR by more than 5 degrees was identified as a significant predictive indicator for potential concomitant ligament insufficiency (area under curve = 0.875, P < .001) showing 80.9% of the sensitivity, 82.1% of the specificity. Conclusions In the surgical treatment of recalcitrant lateral epicondylitis, lateral ulnar collateral ligament reconstruction added to the débridement of extensor origin may provide better results for the patients with suspicious lateral ligament insufficiency or failed previous surgery.
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Role of ultrasound-guided perineural injection of the posterior antebrachial cutaneous nerve for diagnosis and potential treatment of chronic lateral elbow pain. Skeletal Radiol 2021; 50:425-430. [PMID: 32856094 DOI: 10.1007/s00256-020-03594-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine diagnostic and therapeutic utility of novel ultrasound-guided perineural injection of posterior antebrachial cutaneous nerve in chronic lateral elbow pain. MATERIALS AND METHODS We performed a retrospective analysis of ultrasound-guided perineural injection of the posterior antebrachial cutaneous nerve with local anesthetic with or without corticosteroid in patients with chronic lateral elbow pain. Data variables collected included patient demographics, illness course, diagnostic ultrasound findings, immediate pre- and post-injection pain using numeric rating pain scale between 0 and 10, injection complications, and post-injection outcomes. RESULTS Fifteen patients (9 females and 6 males) with average age 46.9 (range 16-69 years) underwent 20 perineural injections between 2009 and 2019. Patients had on average 84% reduction in pain immediately after the injection (median pre- and post-procedure numeric rating pain scale of 6 and 0, respectively, p < 0.001). Patients had pain relief for an average of 15 h (range 2-48 h) when only local anesthetic was injected, compared with average pain relief of 26.5 days (range 2 h-43 days) when local anesthetic was combined with corticosteroid, p = 0.01. CONCLUSION Novel ultrasound-guided perineural anesthetic injections around the posterior antebrachial cutaneous nerve can be performed safely and have diagnostic and potentially therapeutic utility in select patients with chronic refractory lateral elbow pain.
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Nguyen ML, Rosenthal J, Umpierrez M, Lourie GM, Singer AD. MRN findings of lateral antebrachial cutaneous nerve impingement in a collegiate athlete. Skeletal Radiol 2020; 49:809-814. [PMID: 31807874 DOI: 10.1007/s00256-019-03345-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
Dynamic compression of the lateral antebrachial cutaneous nerve (LABCN) occurs with forearm pronation when the LABCN becomes compressed by the lateral margin of the biceps tendon. LABCN compression is a rare occurrence and is often overlooked as an etiology for forearm pain. While this entity has been described in several case reports in the orthopedic literature, it has not yet been described in radiology literature. We present a case of LABCN compression by the biceps tendon which was suggested by high-resolution magnetic resonance neurography in combination with the clinical findings and was subsequently confirmed and corrected surgically.
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Affiliation(s)
- My-Linh Nguyen
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Jeffrey Rosenthal
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Gary M Lourie
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA.,The Hand and Upper Extremity Center of Georgia, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
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Almeer G, Azzopardi C, Kho J, Botchu R. Myositis ossificans of mobile wad of Henry-Tennis elbow mimic. Indian J Radiol Imaging 2020; 30:89-91. [PMID: 32476757 PMCID: PMC7240889 DOI: 10.4103/ijri.ijri_453_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/17/2019] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Lateral epicondylitis also known as “tennis elbow” is the most common cause of lateral elbow pain. Several pathologies can mimic symptoms of tennis elbow. We present a case of myositis ossificans within the mobile wad of Henry (MWH), which presented with symptoms of tennis elbow and believe this to be the first reported case in literature.
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Affiliation(s)
- Ghassan Almeer
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - James Kho
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Zhu B, You Y, Xiang X, Wang L, Qiu L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg 2020; 10:211-219. [PMID: 31956543 DOI: 10.21037/qims.2019.10.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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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Affiliation(s)
- Bihui Zhu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yingqi You
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liyun Wang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
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Strength-Duration Curves of Radial Nerve in Patients With Lateral Elbow Pain. J Sport Rehabil 2019; 29:754-759. [PMID: 31629328 DOI: 10.1123/jsr.2018-0405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Lateral epicondylalgia (LE) refers to a painful condition at or around the lateral epicondyle of the humerus. LE is one of the most common injuries of the elbow; however, the cause of the pathology is not clear. Patients often experience symptoms consistent with a radial nerve injury; however, data on the involvement of the radial nerve are needed. OBJECTIVE To analyze the relationship between electrophysiologic excitability and morphology of the radial nerve in patients with unilateral chronic LE. DESIGN Cross-sectional study. SETTING Department of Physiotherapy, University of Seville. PATIENTS A total of 56 elbows (28 right, 28 left) in 28 patients (12 females, 16 males; age 49 [7.37] y) were recruited by convenience sampling. MAIN OUTCOME MEASURES Strength-duration curves (chronaxia and accommodation index) and cross-sectional area (CSA) of the radial nerve were made in all participants. All parameters were compared between both limbs. Also, pain with palpation in the lateral epicondyle and functional pain of involved extremities was assessed using visual analog scale and the Patient-Rated Tennis Elbow Evaluation, respectively. RESULTS Symptomatic limb showed higher CSA values of the radial nerve when compared with the asymptomatic limb (P < .001). On the symptomatic limb, duration of symptoms was positively correlated with CSA values. Chronaxia values were all normal and similar between both limbs (P = .35). Regarding accommodation index, 14 (54%) patients showed accommodation indices that suggested pathological radial nerve on the right limb, 4 (14%) on the left limb, 5 (18%) on both limbs, and 4 (14%) had none of the affected nerves. Eight-six percent of patients showed accommodation indices that suggested pathological radial nerve, independently of symptomatic limb. In these cases, affected nerves had higher CSA than the unaffected nerve (P = .01). On the affected nerves, duration of symptoms was positively correlated with accommodation indices. CONCLUSIONS These findings suggest that patients with unilateral chronic LE show a decreased excitability in any radial nerve, independently of the symptomatic limb, and that pathological nerves have higher CSA than the nonpathological nerves.
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Keijsers R, de Vos RJ, Kuijer PPFM, van den Bekerom MPJ, van der Woude HJ, Eygendaal D. Tennis elbow. Shoulder Elbow 2019; 11:384-392. [PMID: 31534489 PMCID: PMC6739751 DOI: 10.1177/1758573218797973] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 01/19/2023]
Abstract
Tennis elbow is the most common cause of lateral-sided elbow pain with a major socioeconomic impact. The etiology of tennis elbow is not completely understood, but there are many different treatment options. This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation.
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Affiliation(s)
- Renée Keijsers
- Department of Orthopaedic Surgery,
Amsterdam UMC, Amsterdam, the Netherlands
| | | | - P Paul FM Kuijer
- Coronel Institute of Occupational
Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Michel PJ van den Bekerom
- Department of Orthopaedic Surgery, Onze
Lieve Vrouwe Gasthuis (O.L.V.G.), Amsterdam, the Netherlands
| | - Henk-Jan van der Woude
- Department of Radiology, Onze Lieve
Vrouwe Gasthuis (O.L.V.G.), Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery,
Amsterdam UMC, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery,
Amphia Hospital, Breda, the Netherlands
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18
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Park KB, Kim SJ, Chun YM, Yoon TH, Choi YS, Jung M. Clinical and diagnostic outcomes in arthroscopic treatment for posterolateral plicae impingement within the radiocapitellar joint. Medicine (Baltimore) 2019; 98:e15497. [PMID: 31045835 PMCID: PMC6504535 DOI: 10.1097/md.0000000000015497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Synovial plica is rarely diagnosed as cause of elbow pain. Impingemnt of posterolateral plicae in the radiocapitellar joint tends to be usually overlooked. The purpose of this study was to present outcomes of arthroscopic treatment in relatively large number of cases and propose reliable diagnostic test for posterolateral plicae of the radiocapitellar joint.From January 2000 to December 2010, 24 cases diagnosed with pathologic posterolateral radiocapitellar plica on arthroscopic finding were retrospectively reviewed. Magnetic resonance imaging (MRI) evaluation and preoperative physical examination were performed. The posterolateral radiocapitellar plica test newly proposed by the present study was also conducted. To measure postoperative clinical outcomes, the disabilities of the arm, shoulder, and hand (DASH) score and Mayo elbow performance score (MEPS) were employed. Minimum duration of follow up was 24 months.According to the preoperative MRI, pathologic radiocapitellar plica was identified in 17 cases (70.8%). Preoperatively, maximal tender point was present on the radiocapitellar joint line in 20 cases (83.3%) and mechanical symptoms were observed in 9 cases (37.5%). 6 cases (25%) demonstrated pain at terminal extension and limitation of extension. 20 (83.3%) cases tested positive for posterolateral radiocapitellar plica test. The sensitivity and specificity of the posterolateral radiocapitellar plica test were 83.3% and 87.5%, respectively. The accuracy value was 86.3%. Arthroscopic debridement of pathologic plica in the radiocapitellar joint demonstrated clinical improvements: DASH score was from 36.6 to 8.9 and MEPS was from 56.9 to 95.6 at the latest follow-up.Symptomatic impingement by the pathologic posterolateral plica of the radiocapitellar joint should be considered when posterolateral elbow pain which is refractory to conservative treatment, and other prevalent diseases are excluded. The posterolateral radiocapitellar plica test and radiocapitellar joint line tenderness could be recommended as reliable examination maneuvers to obtain accurate diagnosis. Arthroscopic debridement was an effective method for treating symptomatic plicae.
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Affiliation(s)
| | - Sung-Jae Kim
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hwan Yoon
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | | | - Min Jung
- The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Speers CJ, Bhogal GS, Collins R. Lateral elbow tendinosis: a review of diagnosis and management in general practice. Br J Gen Pract 2018; 68:548-549. [PMID: 30361321 PMCID: PMC6193783 DOI: 10.3399/bjgp18x699725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/15/2018] [Indexed: 10/31/2022] Open
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20
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Choi YD, Kim MJ, Lee JH. Effects of concentric contraction of the wrists and transcutaneous electrical nerve stimulation cycle on pain and muscle strength in lateralepicondylitis patients. J Phys Ther Sci 2018; 29:2081-2084. [PMID: 29643577 PMCID: PMC5890203 DOI: 10.1589/jpts.29.2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/04/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effects of transcutaneous electrical nerve stimulation and concentric contraction of the muscles surrounding the elbow joints on pain and muscular strength in the elbow joints of patients with lateral epicondylitis. [Subjects and Methods] The subjects of this study were 30 patients who visited our hospital with the main complaint of lateral pain in the elbow joint. All subjects were randomly and equally assigned to an experimental group that conducted concentric contraction exercises in sync with a transcutaneous electrical nerve stimulation cycle and a control group that performed concentric contraction after the application of transcutaneous electrical nerve stimulation. Patients used a 10 cm visual analogue scale to evaluate the level of pain in their elbow joints. To measure the strength of muscles around the elbow joints, the subjects' paretic grip strength was measured using an electronic grip strength dynamometer. [Results] No statistically significant difference in visual analog scale was found between the two groups. Regarding changes in grip strength, changes in the experimental group's grip strength were significantly greater than those in the control group. [Conclusion] These results can be used as a basis for reducing pain and improving strength in lateral epicondylitis patients.
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Affiliation(s)
- Yeong-Deok Choi
- Department of Physical Therapy, Kyungdong University: Bongpo-ri, Toseong-myeon, Goseong-gun, Gangwon-do, Republic of Korea
| | - Myung-Joon Kim
- Department of Physical Therapy, Kyungdong University: Bongpo-ri, Toseong-myeon, Goseong-gun, Gangwon-do, Republic of Korea
| | - Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University: Bongpo-ri, Toseong-myeon, Goseong-gun, Gangwon-do, Republic of Korea
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Arslan S, Karahan AY, Oncu F, Bakdik S, Durmaz MS, Tolu I. Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:585-593. [PMID: 28850740 DOI: 10.1002/jum.14369] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis. METHODS A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared. RESULTS When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001). CONCLUSIONS The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging.
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Affiliation(s)
- Serdar Arslan
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Therapy and Rehabilitation, Usak University School of Medicine, Usak, Turkey
| | - Fatih Oncu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Suleyman Bakdik
- Department of Radiology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Ismet Tolu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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Gürçay E, Karaahmet ÖZ, Kara M, Onat SS, Ata AM, Ünlü E, Özçakar L. Ultrasonographic Evaluation of the Radial Nerves in Patients with Unilateral Refractory Lateral Epicondylitis. PAIN MEDICINE 2017; 18:396-402. [PMID: 27477582 DOI: 10.1093/pm/pnw181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. Design Cross-sectional study. Setting Three physical medicine and rehabilitation departments. Subjects Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. Methods All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. Results When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P < 0.001). Grip strength values were lower on the affected sides ( P < 0.001). Electrophysiological studies were all normal, and similar between the two sides (all P > 0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P < 0.01). Conclusions Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment.
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Affiliation(s)
- Eda Gürçay
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Özgür Zeliha Karaahmet
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Sule Sahin Onat
- Ankara Physical and Rehabilitation Medicine Education and Research Hospital, Ankara, Turkey
| | - Ayse Merve Ata
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ece Ünlü
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Maida E, Chiavaras MM, Jelsing EJ, O'Driscoll SW, Pawlina W, Smith J. Sonographic Visualization of the Posterior Cutaneous Nerve of the Forearm: Technique and Validation Using Perineural Injections in a Cadaveric Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1627-1637. [PMID: 28390161 DOI: 10.7863/ultra.16.08027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/21/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the ability to sonographically identify the posterior cutaneous nerve of the forearm (PCNF) and its distal epicondylar branches using sonographically guided perineural injections in an unembalmed cadaveric model. METHODS A single experienced operator used a 12-3-MHz linear array transducer to identify the PCNF and its distal epicondylar region branches in 10 unembalmed cadaveric specimens (6 right and 4 left) obtained from 10 donors. Sonographically guided perineural PCNF injections were then completed with a 22-gauge, 38-mm stainless steel needle to deliver 0.25 mL of 50% diluted colored latex at 3 points along the PCNF. The latex location was then confirmed via dissection. RESULTS The 10 donors included 4 male and 6 female cadavers aged 48 to 94 years (mean, 73 years) with body mass indices of 19 to 37 kg/m2 (mean, 26 kg/m2 ). The operator sonographically identified the PCNF and several distal branches traversing over or directly adjacent to the lateral epicondyle in all 10 specimens. Only 7 of 10 specimens showed a distinct PCNF bifurcation into anterior and posterior divisions, and all 7 were accurately identified and localized on sonography. There was no evidence of latex overflow to clinically relevant adjacent structures or injury to regional vessels or nerves. CONCLUSIONS High-resolution sonography can identify the PCNF and its distal epicondylar branches. Sonographic evaluation of the PCNF should be included in the evaluation of patients presenting with refractory or atypical lateral elbow pain syndromes. Diagnostic and therapeutic sonographically guided procedures targeting the PCNF or its lateral epicondylar branches are feasible and warrant further investigation.
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Affiliation(s)
- Eugene Maida
- Departments of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Mary M Chiavaras
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Elena J Jelsing
- Departments of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shawn W O'Driscoll
- Department of Orthopedics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Wojciech Pawlina
- Department of Anatomy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jay Smith
- Departments of Physical Medicine and Rehabilitation, Radiology, and Anatomy, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
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Choi SH, Ji SK, Lee SA, Park MJ, Chang MJ. Magnetic resonance imaging of posterolateral plica of the elbow joint: Asymptomatic vs. symptomatic subjects. PLoS One 2017. [PMID: 28622337 PMCID: PMC5473528 DOI: 10.1371/journal.pone.0174320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) may be useful to diagnose a posterolateral plica syndrome of the elbow joint because this syndrome has less clear clinical features. The purposes of this study were to document mediolateral and sagittal dimensions of a posterolateral synovial fold and to determine the proportion of subjects with the posterolateral plica in asymptomatic elbows. We also aimed to determine whether the dimensions of the posterolateral synovial fold and the prevalence of the plica differ between symptomatic and asymptomatic subjects. Materials and methods This retrospective review of prospectively collected data included 50 asymptomatic elbows (asymptomatic group) and 14 elbows with arthroscopically confirmed posterolateral plicae (plica group). The mediolateral and sagittal dimensions of the posterolateral synovial fold were measured. In addition, the criteria for the prevalence of posterolateral plica was determined with conventional MRI as synovial fold dimension ≥ 3 mm and coverage of radial head by synovial fold ≥ 30%. Results The plica group showed larger posterolateral synovial fold dimensions compared to the asymptomatic group. The median mediolateral and sagittal dimensions of the synovial fold in the asymptomatic group were 3.8 mm and 4.7 mm, respectively. Dimensions in the plica group were 7.0 mm and 7.4 mm, respectively. When the presence of posterolateral plica was determined using the dimension criteria, there was no difference in the prevalence of the plica between the asymptomatic and the plica group. However, using the coverage criteria, the prevalence of posterolateral elbow plica was significantly greater in the plica group than the asymptomatic group (64% vs. 18%; p < 0.001). Conclusions The patients who underwent arthroscopic surgery for posterolateral plica syndrome had larger dimensions of the posterolateral synovial fold and higher prevalence of the posterolateral plica on conventional MRI compared to the asymptomatic subjects.
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Affiliation(s)
- Sang-Hee Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suk Kyeong Ji
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea
- * E-mail:
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Abstract
Lateral epicondylitis, also known as ‘tennis elbow’, is a very common condition affecting mainly middle-aged patients. The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. The diagnosis is usually clinical but some patients may benefit from additional imaging for a specific differential diagnosis. The disease has a self-limiting course of between 12 and 18 months, but in some patients, symptoms can be persistent and refractory to treatment. Most patients are well-managed with non-operative treatment and activity modification. Many surgical techniques have been proposed for patients with refractory symptoms. New non-operative treatment alternatives with promising results have been developed in recent years.
Cite this article: Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev 2016;1:391-397. DOI: 10.1302/2058-5241.1.000049.
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Affiliation(s)
| | - Raul Barco
- Hospital Universitario La Paz, Madrid, Spain
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Kani K, Porrino J, Dahiya N, Taljanovic M, Mulcahy H, Chew F. Visualization of the Soft Tissues at the Lateral and Medial Epicondyles of the Elbow. PM R 2016; 9:533-539. [PMID: 27816532 DOI: 10.1016/j.pmrj.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Kimia Kani
- Virginia Radiology Associates, P.C., Manassas, VA(∗)
| | - Jack Porrino
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195(†).
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic - Scottsdale, Phoenix, AZ(‡)
| | | | - Hyojeong Mulcahy
- Department of Radiology, University of Washington, Seattle, WA(¶)
| | - Felix Chew
- Department of Radiology, University of Washington, Seattle, WA(#)
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Abstract
Synopsis Clear guidelines for the clinical management of individuals with lateral elbow tendinopathy (LET) are hampered by many proposed interventions and the condition's prognosis, ranging from immediate resolution of symptoms following simple advice in some patients to long-lasting problems, regardless of treatment, in others. This is compounded by our lack of understanding of the complexity of the underlying pathophysiology of LET. In this article, we collate evidence and expert opinion on the pathophysiology, clinical presentation, and differential diagnosis of LET. Factors that might provide prognostic value or direction for physical rehabilitation, such as the presence of neck pain, tendon tears, or central sensitization, are canvassed. Clinical recommendations for physical rehabilitation are provided, including the prescription of exercise and adjunctive physical therapy and pharmacotherapy. A preliminary algorithm, including targeted interventions, for the management of subgroups of patients with LET based on identified prognostic factors is proposed. Further research is needed to evaluate whether such an approach may lead to improved outcomes and more efficient resource allocation. J Orthop Sports Phys Ther 2015;45(11):938-949. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5841.
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Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother 2015; 61:174-81. [PMID: 26361816 DOI: 10.1016/j.jphys.2015.07.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- Leanne M Bisset
- Menzies Health Institute Queensland, Griffith University, Gold Coast
| | - Bill Vicenzino
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy and the NHMRC Centre for Research Excellence in Spinal Pain, Injury and Health, Brisbane, Australia
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Singer AD, Hanna T, Jose J, Datir A. A systematic, multimodality approach to emergency elbow imaging. Clin Imaging 2015; 40:13-22. [PMID: 26454616 DOI: 10.1016/j.clinimag.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 11/16/2022]
Abstract
The elbow is a complex synovial hinge joint that is frequently involved in both athletic and nonathletic injuries. A thorough understanding of the normal anatomy and various injury patterns is essential when utilizing diagnostic imaging to identify damaged structures and to assist in surgical planning. In this review, the elbow anatomy will be scrutinized in a systematic approach. This will be followed by a comprehensive presentation of elbow injuries that are commonly seen in the emergency department accompanied by multimodality imaging findings. A short discussion regarding pitfalls in elbow imaging is also included.
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Affiliation(s)
- Adam D Singer
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Tarek Hanna
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jean Jose
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Abhijit Datir
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
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Kocyigit F, Kuyucu E, Kocyigit A, Herek DT, Savkin R, Aslan UB, Karabulut N. Association of real-time sonoelastography findings with clinical parameters in lateral epicondylitis. Rheumatol Int 2015; 36:91-100. [DOI: 10.1007/s00296-015-3356-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022]
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Accuracy testing of four physical examination maneuvers for detecting lateral epicondylitis. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chiavaras MM, Jacobson JA, Billone L, Lawton JM, Lawton J. Sonography of the lateral antebrachial cutaneous nerve with magnetic resonance imaging and anatomic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1475-1483. [PMID: 25063413 DOI: 10.7863/ultra.33.8.1475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Abnormalities of the lateral antebrachial cutaneous nerve (LABCN) are associated with antecubital elbow conditions, such as distal biceps brachii tendon tears and traumatic cephalic vein phlebotomy. These can lead to lateral forearm, elbow, and wrist symptoms that can mimic other disease processes. The purpose of this study was to characterize the sonographic appearance of the LABCN using cadaveric dissection and retrospective analysis of sonographic examinations of symptomatic patients with magnetic resonance imaging correlation. METHODS For the first part of this study, a cadaveric elbow specimen was examined, and sonography was performed after dissection to identify the LABCN. Subsequently, 26 elbows in 13 patients with LABCN abnormalities were identified with sonography and retrospectively evaluated to characterize the appearance of the LABCN in both symptomatic and asymptomatic elbows. RESULTS The symptomatic LABCNs showed fusiform enlargement, increased echogenicity, and loss of the normal fascicular echo texture. The mean cross-sectional area of the symptomatic nerves was 12.0 mm(2) (range, 6.1-17.2 mm(2)), with a maximum thickness of 3.5 mm (range, 2.3-5.9 mm), compared to 3.3 mm(2) (range, 1.9-5.2 mm(2)), with a maximum thickness of 1.3 mm (range, 0.9-2.2 mm), in the contralateral normal elbows. CONCLUSIONS The close proximity of the LABCN to the distal biceps tendon and the cephalic vein makes it vulnerable to compression and injury in the setting of distal biceps tendon tears and traumatic phlebotomy, which may cause nerve enlargement and increased echogenicity. Awareness of the location and appearance of the LABCN on sonography is important for determining potential causes of lateral elbow and forearm pain.
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Affiliation(s)
- Mary M Chiavaras
- Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.M.C., L.B.); and Departments of Radiology (J.A.J.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA.
| | - Jon A Jacobson
- Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.M.C., L.B.); and Departments of Radiology (J.A.J.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA
| | - Lisa Billone
- Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.M.C., L.B.); and Departments of Radiology (J.A.J.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA
| | - Jason Michael Lawton
- Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.M.C., L.B.); and Departments of Radiology (J.A.J.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA
| | - Jeffrey Lawton
- Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.M.C., L.B.); and Departments of Radiology (J.A.J.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA
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Jacobson JA, Chiavaras MM, Lawton JM, Downie B, Yablon CM, Lawton J. Radial collateral ligament of the elbow: sonographic characterization with cadaveric dissection correlation and magnetic resonance arthrography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1041-1048. [PMID: 24866611 DOI: 10.7863/ultra.33.6.1041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES An abnormality of the radial collateral ligament (RCL) in the setting of lateral epicondylitis can indicate a poor clinical outcome; therefore, accurate assessment is important. The purpose of this study was to characterize the proximal RCL attachment, or footprint, as seen on sonography using cadaveric dissection correlation and magnetic resonance arthrography. METHODS For the first part of this study, 4 cadaveric elbow specimens were imaged with sonography before and after dissection to characterize the RCL. After Institutional Review Board approval with consent waived, 26 consecutive magnetic resonance (MR) arthrograms of the elbow were identified. The sonograms and MR arthrograms were retrospectively reviewed to measure the length of the RCL footprint and its percentage of the combined RCL and common extensor tendon (CET) humeral footprints. RESULTS The mean RCL footprint length and percentage of the combined RCL and CET footprints were 8.4 mm (range, 7.4-10.0 mm) and 54% as measured from the elbow specimen sonograms and 9.1 mm (range, 6.4-12.5 mm) and 54% as measured from the MR arthrograms. The mean RCL footprint length combining data from specimens and MR arthrograms was 8.9 mm (range, 6.4-12.5 mm), covering 54% of the combined RCL and CET footprints. CONCLUSIONS The RCL can be differentiated from the CET on sonography with knowledge of the RCL humeral footprint extent, which measured 8.9 mm in length and comprised 54% of the combined RCL and CET footprints.
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Affiliation(s)
- Jon A Jacobson
- Departments of Radiology (J.A.J., B.D., C.M.Y.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA; and Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada.
| | - Mary M Chiavaras
- Departments of Radiology (J.A.J., B.D., C.M.Y.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA; and Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Jason Michael Lawton
- Departments of Radiology (J.A.J., B.D., C.M.Y.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA; and Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Brian Downie
- Departments of Radiology (J.A.J., B.D., C.M.Y.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA; and Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Corrie M Yablon
- Departments of Radiology (J.A.J., B.D., C.M.Y.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA; and Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Jeffrey Lawton
- Departments of Radiology (J.A.J., B.D., C.M.Y.) and Orthopedic Surgery (J.M.L., J.L.), University of Michigan, Ann Arbor, Michigan USA; and Department of Diagnostic Imaging, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
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Ultrasound Elastography of Lateral Epicondylosis: Clinical Feasibility of Quantitative Elastographic Measurements. AJR Am J Roentgenol 2014; 202:1094-9. [DOI: 10.2214/ajr.13.11003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
CONTEXT The elbow is a complex joint and commonly injured in athletes. Evaluation of the elbow by magnetic resonance imaging (MRI) is an important adjunct to the physical examination. To facilitate accurate diagnosis, a concise structured approach to evaluation of the elbow by MRI is presented. EVIDENCE ACQUISITION A PubMed search was performed using the terms elbow and MR imaging. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the MRI appearance of normal anatomy and common pathology of the elbow. RESULTS The spectrum of common elbow disorders varies from obvious acute fractures to chronic overuse injuries whose imaging manifestations can be subtle. MRI evaluation should include bones; lateral, medial, anterior, and posterior muscle groups; the ulnar and radial collateral ligaments; as well as nerves, synovium, and bursae. Special attention should be paid to the valgus extension overload syndrome and the MRI appearance of associated injuries when evaluating throwing athletes. CONCLUSION MRI evaluation of the elbow should follow a structured approach to facilitate thoroughness, accuracy, and speed. Such an approach should cover bone, cartilage, muscle, tendons, ligaments, synovium, bursae, and nerves.
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Affiliation(s)
- Srinath C Sampath
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Srihari C Sampath
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miriam A Bredella
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report. J Orthop Sports Phys Ther 2013; 43:841-7. [PMID: 24175610 DOI: 10.2519/jospt.2013.4659] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established. CASE DESCRIPTION The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period. OUTCOMES Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner. DISCUSSION The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia. LEVEL OF EVIDENCE Therapy, level 4.
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Minaya-Muñoz F, Medina-Mirapeix F, Valera-Garrido F. Quality measures for the care of patients with lateral epicondylalgia. BMC Musculoskelet Disord 2013; 14:310. [PMID: 24172311 PMCID: PMC3816543 DOI: 10.1186/1471-2474-14-310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022] Open
Abstract
Background Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments. The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE. Methods Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel. Results Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8). Conclusions A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.
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Affiliation(s)
- Francisco Minaya-Muñoz
- MVClinic, Juan Antonio Samaranch Torelló St,, 6B, Fitness Sports Center Valle de Las Cañas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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38
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Abstract
Lateral epicondylitis, or ’tennis elbow’, is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments. Cite this article: Bone Joint J 2013;95-B:1158–64.
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Affiliation(s)
- Z. Ahmad
- Norfolk and Norwich University Hospital, Department
of Orthopaedics, Colney Lane, Norwich
NR4 7UR, UK
| | - N. Siddiqui
- Princess Alexandra Hospital, Brisbane
Hand and Upper Limb Unit, Woolloongabba, Brisbane 4002, Australia
| | - S. S. Malik
- Ipswich Hospital, Ipswich
Heath Road, Ipswich, Suffolk
IP4 5PD, UK
| | - M. Abdus-Samee
- University Hospital Lewisham, Lewisham
Healthcare NHS Trust, Lewisham High Street, London SE13
6LH, UK
| | | | - N. Rushton
- Orthopaedic Research Unit, University
of Cambridge, Box 180, Addenbrookes
Hospital, Hills Road, Cambridge
CB2 0QQ, UK
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Ruiz de Luzuriaga BC, Helms CA, Kosinski AS, Vinson EN. Elbow MR imaging findings in patients with synovial fringe syndrome. Skeletal Radiol 2013; 42:675-80. [PMID: 23011477 DOI: 10.1007/s00256-012-1523-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe imaging findings in patients with synovial fringe (SF) syndrome of the elbow and to compare with a control population. MATERIALS AND METHODS Nine patients (5 men, 4 women) whose mean age was 35.7 years were diagnosed with SF syndrome and had undergone preoperative elbow MRI. The radiohumeral (RH) plica was assessed for thickness, cross-sectional area, coverage of one third or more of the radial head, blunting of the free edge, and T2 signal intensity abnormality. Other abnormalities of the RH joint were also assessed, including adjacent articular cartilage defects, subcortical bone marrow signal abnormality in the capitellum, and synovitis. Results were compared with 15 control patients who were asymptomatic laterally and posteriorly. RESULTS Mean thickness and cross-sectional area of the RH plica were 1.8 mm and 19.4 mm(2) respectively in controls, compared with 2.5 mm and 21.9 mm(2) respectively in symptomatic patients. No statistically significant differences in the distribution of the mean thickness or cross-sectional area of the RH plica were found between the two groups. However, 67% of SF syndrome patients had a RH plica thickness greater than 2.6 mm compared with only 13% of controls (p = 0.021). Other abnormalities of the RH plica occurred more frequently in patients with SF syndrome compared with controls, but were not statistically significant. CONCLUSION In patients presenting with posterolateral pain or mechanical symptoms in the elbow, RH plica thickness greater than 2.6 mm on elbow MRI examinations may help identify patients with SF syndrome.
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