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Ricci V, Cocco G, Mezian K, Chang KV, Naňka O, Tamborrini G, Kara M, Özçakar L. Anatomy and Sonographic Examination for Lateral Epicondylitis: EURO-MUSCULUS/USPRM Approach. Am J Phys Med Rehabil 2023; 102:300-307. [PMID: 36002120 DOI: 10.1097/phm.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study is to define a standardized comprehensive sonographic approach for evaluating the different histoanatomical compartments of the lateral elbow. DESIGN Using high-frequency ultrasound probes, we tried to match the anatomical features of the lateral elbow and its different sonographic patterns in patients with the diagnosis of lateral epicondylitis. Moreover, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS Modern ultrasound equipment seems to provide an extremely detailed sonographic assessment of the different anatomical layers located in the lateral compartment of the elbow. Moreover, high-sensitive color/power Doppler imaging allows for clear visualization of the perfusion patterns in pathological conditions. CONCLUSIONS In clinical practice, high-frequency B-mode and high-sensitive color/power Doppler imaging can be integrated with the clinical findings to better define the pain generator(s) for optimizing the management of patients with lateral epicondylitis.
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Affiliation(s)
- Vincenzo Ricci
- From the Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy (GC); Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic (KM); Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan (K-VC); Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic (ON); UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland (GT); Rheumatology Clinic, University Hospital of Basel, Basel, Switzerland (GT); and Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ)
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Ricci V, Mezian K, Cocco G, Tamborrini G, Fari G, Zunica F, Chang KV, Kara M, Özçakar L. Ultrasonography for Injecting (Around) the Lateral Epicondyle: EURO-MUSCULUS/USPRM Perspective. Diagnostics (Basel) 2023; 13:diagnostics13040717. [PMID: 36832216 PMCID: PMC9955720 DOI: 10.3390/diagnostics13040717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Lateral epicondylitis (LE) is a very common and painful condition seen in the daily practice of musculoskeletal physicians. Ultrasound-guided (USG) injections are commonly performed to manage the pain, promote the healing phase, and plan a tailored rehabilitation treatment. In this aspect, several techniques were described to target specific pain generators i the lateral elbow. Likewise, the aim of this manuscript was to extensively review those USG techniques together with the patients' pertinent clinical/sonographic features. The authors believe that this literature summary could also be refined as a practical, ready-to-use guide for planning the USG interventions of the lateral elbow in clinical practice.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
- Correspondence: ; Tel.: +39-3381137042
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University, 12800 Prague, Czech Republic
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, University “G. d’Annunzio”, 66100 Chieti, Italy
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, 4051 Basel, Switzerland
- Rheumatology Clinic, University Hospital of Basel, 4001 Basel, Switzerland
| | - Giacomo Fari
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey
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Bilger R, Laumonerie P, Barret H, Lapègue F, Mansat P, Sans N, Faruch-Bilfeld M. Ultrasonography: an interesting imaging method for ligament assessment during the acute phase of closed elbow injuries. J Med Ultrason (2001) 2022; 49:739-746. [PMID: 35943621 DOI: 10.1007/s10396-022-01246-y] [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: 01/19/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate whether ultrasonography can be used to explore the medial and lateral ligament structures during the acute phase of a closed elbow injury. METHODS A single-center, prospective study performed between December 2019 and June 2020, including patients who suffered a radial head fracture or elbow dislocation. Two radiologists did a blinded analysis using ultrasonography of visibility, injury grade, and presence of bone avulsion for the radial collateral ligament (RCL), lateral ulnar collateral ligament (LUCL), annular ligament (AL), and anterior (MCLant) and posterior bundles (MCLpost) of the medial collateral ligament. The inter-rater agreement was calculated. The ultrasonography findings were compared with the intraoperative findings in the patients who subsequently underwent surgery. RESULTS Forty patients were included (28 radial head fractures and 12 elbow dislocations). The inter-rater agreement was strong for all the study parameters (kappa between 0.65 and 1), except for the visibility of the LUCL (kappa 0.52) and the visibility and appearance of the MCLpost (kappa 0.54 and 0.47, respectively). The injured ligaments were thicker than their contralateral counterparts (p < 0.05). In the 10 patients who underwent surgery, the radiological-surgical correlation was 100% for the RCL and medial ligaments and 70% for the LUCL. CONCLUSION Ultrasonography is a reproducible examination that can be used to assess the damage to elbow ligaments during the acute phase following an injury. This examination could be incorporated into the exploration protocol for elbow injuries during the preoperative assessment and to adapt the treatment.
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Affiliation(s)
- Romain Bilger
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France.
| | - Pierre Laumonerie
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France.,Service de Chirurgie Orthopédique, Hôpital Pellegrin, 33000, Bordeaux, France
| | - Hugo Barret
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Franck Lapègue
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Pierre Mansat
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Nicolas Sans
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Marie Faruch-Bilfeld
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
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Ricci V, Güvener O, Chang KV, Wu WT, Mezian K, Kara M, Leblebicioğlu G, Pirri C, Ata AM, Dughbaj M, Jain NB, Stecco C, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Elbow. Am J Phys Med Rehabil 2022; 101:e83-e92. [PMID: 34930863 DOI: 10.1097/phm.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In this dynamic protocol, ultrasound examination of the elbow using different maneuvers is described for several/relevant elbow problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide-prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine])-will help musculoskeletal physicians perform a better and uniform/standard approach.
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Affiliation(s)
- Vincenzo Ricci
- From the Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan (K-VC, W-TW); National Taiwan University College of Medicine, Taipei, Taiwan (K-VC); Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (KM); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ); The Hand Clinic, Ankara, Turkey (GL); Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey (AMA); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait City, Kuwait (MD); and Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas (NBJ)
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Arrigoni P, Cucchi D, Luceri F, Zagarella A, Catapano M, Menon A, Bruno V, Gallazzi M, Randelli PS. Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:4067-4074. [PMID: 34455451 PMCID: PMC8595151 DOI: 10.1007/s00167-021-06711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. METHODS Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. RESULTS The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. CONCLUSIONS Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity.
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Affiliation(s)
- Paolo Arrigoni
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Francesco Luceri
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Andrea Zagarella
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Michele Catapano
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Valentina Bruno
- Istituto Clinico San Siro, Via Monreale, 18, 20148 Milan, Italy
| | - Mauro Gallazzi
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,Department of Biomedical Sciences for Health, Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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