Abstract
ObjectiveIs to evaluate the simplicity of 90° flexion/neutral position for ultrasonography assessment of both common extensor and common flexor origins in comparison with the standard position.Material and methodsA standard questionnaire was distributed on 50 trainees, rheumatologists with No previous experience or training in ultrasonography. (They) were attending musculoskeletal training workshops at AL-Azhar rheumatology department musculoskeletal ultrasonography unit in 2016. Each participant then (was) asked to practice US examination of both common extensor and common flexor origins in both positions and then fill four questionnaires, two (of which are) for common flexor and (the other) two (are) for the common extensor origins, in the standard and the other proposed single position. Each questionnaire (whose) answer was graded on scale from 0 to 10, includes the following points:• Time needed to examine the tendon in minutes,• Difficulty in maintaining the probe contact to the skin,• Difficulty in getting good image of the tendon,• The overall impression of simplicity.ResultsDescriptive analysis of the questionnaire results shows that the participants favors the single position in all questionnaire parameters. Comparing means of the four questionnaire parameters in both positions shows highly significant difference in the four parameters at the level of both common flexor and extensor origins in favor of the single position as p > 0.005.ConclusionThe 90 degree flexion/neutral position appears to be simpler than the standard position for ultrasonography assessment of common extensor and common flexor tendons at the elbow.
Highlights
The 90 degree flexion/neutral position appears to be simpler than the standard position for ultrasonography assessment of common extensor and common flexor tendons at the elbow
Abogamal et al Advances in Rheumatology (2019) 59:11. During this position, maintaining and stabilizing the probe in good contact with the patient skin may encounter some difficulties especially for the beginners at initial US basic training because of normal anatomical angular articulation between the humerus, ulna, and radius [8]. We proposed another positon for the assessment of both common extensor and common flexor origins by positioning the probe longitudinally pointing to the medial and lateral epicondyles, parallel to radius and ulna while the patient in the same position for triceps tendon assessment Posterior scan (90° flexion/neutral position)
Each participant was instructed about US examination of both common extensor and common flexor origins in both positions by two different instructors one for each position: The standard lateral humero-radial longitudinal scan and the medial humero-ulnar longitudinal scan. 7, and the 90° flexion/neutral position with positioning the probe longitudinally pointing to the medial and lateral epicondyles
Summary
Elbow pain represents a frequent complaint that encountered in the rheumatologist daily practice, and ultrasonography (US) can efficiently support the clinical examination by much valuable information about ligaments, synovium, joint space, and tendon insertions [1,2,3,4].Pain and inflammation at the common extensor and common flexor origins are frequently responsible for pain around the elbow and both US can readily assess them to detect any tendon or insertion line abnormalities [1,2,3,4].As with all other imaging modalities and regions, US examination of the elbow requires proper orientation of the structure examined, positioning of the patient, and efficient training of the examiner [4,5,6]..The standard position for US assessment of the common extensor and common flexor origins is the lateral humero-radial longitudinal scan (along lateral epicondyle) and the medial humero-ulnar longitudinal scan (along medial epicondyle) with the patient extended elbow [7].Abogamal et al Advances in Rheumatology (2019) 59:11During this position, maintaining and stabilizing the probe in good contact with the patient skin may encounter some difficulties especially for the beginners at initial US basic training because of normal anatomical angular articulation between the humerus, ulna, and radius [8].We proposed another positon for the assessment of both common extensor and common flexor origins by positioning the probe longitudinally pointing to the medial and lateral epicondyles, parallel to radius and ulna while the patient in the same position for triceps tendon assessment Posterior scan (90° flexion/neutral position).In that position we could avoid the effect of articulation angle of the elbow, maintain good contact between the probe and the skin, and obtain a good picture for three tendons insertions in one patient position. Abogamal et al Advances in Rheumatology (2019) 59:11 During this position, maintaining and stabilizing the probe in good contact with the patient skin may encounter some difficulties especially for the beginners at initial US basic training because of normal anatomical angular articulation between the humerus, ulna, and radius [8]. We proposed another positon for the assessment of both common extensor and common flexor origins by positioning the probe longitudinally pointing to the medial and lateral epicondyles, parallel to radius and ulna while the patient in the same position for triceps tendon assessment Posterior scan (90° flexion/neutral position).
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