Abstract
Background: Lateral elbow tendinopathy (LET) is prevalent in the upper extremity, with various therapeutic options. Understanding the types and the relations between the radiological tendon features would help to develop more specific treatments. This study reviewed ultrasound exams of LET to investigate the types of degenerative findings and the relationships between them in one of the most prominent sports medicine clinics in Latin America. Methods: A retrospective study was performed. We evaluated 4335 ultrasonographic exams with LET from 2017 and 2018. Five principal degenerative ultrasound criteria with subtypes were selected: hypoechogenicity, neovascularity, calcification, enthesopathy, and intrasubstance tear. A multiple linear regression model was conducted to explore the association between the findings, sex, and age. Results: Overall, 4324 ultrasound exams were analyzed; 2607 (60.29%) were males. Multiple degenerative tendon findings were found in adults (≥18 years) with LET. Hypoechogenicity (67.77%) and neovascularity (37.8%) were the most frequent. The mean length of a tendon tear in both sexes was 4.44 (± 2.81) millimeters. Mild hypoechogenicity (P < .001), and depth intrasubstance tear (P < .01) were statistically significant between them. Severe hypoechogenicity was associated with an increase in all tendon tear dimensions for length 1.37 ([95% Confidence interval (CI), 0.57, 2.17]; P < .001), for width 1.10 ([95% CI, 0.33, 1.87]; P < .01) and for depth 1.64 ([95% CI, 0.40, 2.88]; P < .01). Additional findings associated with an increase in the length dimension were 0.42 associated with focal neovascularity ([95% CI, 0.19, 0.65]; P < .001), and 0.71 associated with multiple neovascularity ([95% CI, 0.27, 1.15]; P < .01). Conclusions: Hypoechogenicity and neovascularity findings presented a positive association with the size of tendon tear in patients with LET. This study reaffirms the increased predominance of tendon tear during the 4th to 6th decades of life.
Highlights
Tendinopathies are a crucial global burden of musculoskeletal disorders.[1]
These structural tendon changes can be identified with imaging methods,[20] ultrasound (US) findings in the degenerative stage has been well documented[21] and can be a useful tool to detect signs such as hypoechoic areas, neovascularization, calcifications, enthesopathy, and intrasubstance tears[22] with better sensitivity and accuracy than magnetic resonance imaging (MRI).[23,24]
A total of 4335 US exams from 2926 patients with suspicion of Lateral elbow tendinopathy (LET) were included in our analysis
Summary
Tendinopathies are a crucial global burden of musculoskeletal disorders.[1]. lateral elbow tendinopathy (LET), or tennis elbow,[2] is one of the most prevalent degenerative conditions in the upper extremity.[3]. These includes collagen disorganization, neurovascular ingrowth,[13] tissue necrosis with myxoid and hyaline degeneration and fibrosis.[14] Most of the degenerative process is concentrated on the extensor carpi radialis brevis (ECRB) tendon.[15,16] These histological changes were first described in 1979.17 In 2009, two researchers proposed an alternative model to describe continuous tendon changes based on three states of its structure: reactive, disrepair and degenerative.[18] in 2016, another investigation included a final phase with gross structural disruption and tendon tear.[19] These structural tendon changes can be identified with imaging methods,[20] ultrasound (US) findings in the degenerative stage has been well documented[21] and can be a useful tool to detect signs such as hypoechoic areas, neovascularization, calcifications, enthesopathy, and intrasubstance tears[22] with better sensitivity and accuracy than magnetic resonance imaging (MRI).[23,24]. This is a unique study with one of the most extensive collections of ultrasound exams analyzed to the best of the authors' knowledge
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