Ultrasound helps to direct surgery in elbow pathology

Abstract

Ultrasound enables us to distinguish patients with elbow problems who will benefit from surgery from patients who need a continuation of conservative treatment. The use of ultrasound in the diagnosis of elbow pain early on when the patient first visits proves invaluable in the patient’s follow-up and treatment. Ultrasound may confirm the diagnosis of medial or lateral epicondylitis. This document can then be used as a baseline to judge the effects of treatment. However, the real purpose of using ultrasound in elbow pain is to exclude other diagnoses that may require surgery. Thickened synovial folds, loose bodies, tears of collateral ligaments can all mimic the pain and focal tenderness caused by extensor or flexor tendon degeneration. The detection of articular pathology changes the management. Surgery is readily used when a mechanical conflict interferes with the patient’s elbow function. With pain or dysfunction as the lead symptoms, we advocate ultrasound to detect: 1) loose bodies (detection/localization) (Frankel, Radiology, 1998) (Takahara, American Journal of Roentgenology, 2000); 2) ulnar and lateral collateral ligament tears (De Smet, Skeletal Radiol, 2002) (Sasaki, JBJS [Am], 2002); 3) lesions of the ulnar nerve (van Holsbeeck/Introcaso, Musculoskeletal Ultrasound, Mosby Yearbook, Elsevier Publishing Co); 4) retained foreign bodies (same ref.); 5) calcifications versus avulsions (same ref.); 6) joint inflammation or infection (same ref.).