Diagnosis Of Lateral Epicondylitis Research Articles

The effectiveness of the use of various methods of shock wave therapy in the complex treatment of athletes with lateral epicondylitis

The purpose of the study: to evaluate the effectiveness of various methods of shock wave therapy in the complex treatment of athletes with lateral epicondylitis.Materials and methods: the study involved 122 people. with a diagnosis of Lateral epicondylitis, aged 20 to 45 years, of which 55 (45.1 %) women and 67 (54.9 %) men. All patients were divided into 4 groups: a control group, which included 28 people who underwent standard treatment, and 3 groups, a total of 94 people, who underwent shock wave procedures using various methods against the background of standard treatment. The examination included the collection of complaints, anamnesis, physical examination, assessment of the function of the upper limb using the QuickDASH questionnaire, assessment of tennis elbow using the PRTEE questionnaire, carpal dynamometry was performed on a MEGEON-34090 dynamometer, and statistical methods. All studies were conducted before, after treatment, as well as after 3 weeks and 1 month. after treatment.Results: shockwave therapy applied to tendons, flexors of the hand, and triceps brachii outperformed shockwaves to tendons or tendons and flexors of the hand in terms of Upper Limb Functional Activity (DASH) (p < 0,05) and score tennis elbow (PRTEE) (p < 0,05) after 3 weeks and after 1 month after treatment.Conclusion: reducing the severity of pain syndrome and functional disorders of the upper limb when performing various types of activities, when conducting shock wave therapy on the area of the tendons, flexor muscles of the hand and the triceps muscle of the shoulder indicates a faster recovery of the functions of the upper limb, which is especially important for athletes.

Differences in Clinical Tests for Assessing Lateral Epicondylitis Elbow in Adults Concerning Their Physical Activity Level: Test Reliability, Accuracy of Ultrasound Imaging, and Relationship with Energy Expenditure.

Physical activity (PA) can generate physical stress on the musculoskeletal system. Thus, the aim of the current study was to assess the influence of the level of physical activity on clinical tests used in the diagnosis of lateral epicondylitis in adults, intertest reliability and accuracy based on ultrasound imaging, and relationship with energy expenditure. 102 adults with lateral epicondylitis were assessed via an International Physical Activity Questionnaire and divided according to PA level: low (n = 19) moderate (n = 42) or high (n = 41). Pain (visual analog scale), Cozen's and Mill's clinical tests and ultrasound exams were performed. The Cozen's and Mill's tests differed among PA levels. Excellent reliability was found for Mill's test for PA levels and the ultrasound exam (low ICC = 1.0, moderate ICC = 0.82 and high ICC = 0.99). Good reliability was found for Cozen's test (low ICC = 0.80, moderate ICC = 0.74 and high ICC = 0.73), but with significant differences between the ultrasound exams. The Cozen's and Mill's clinical tests had no relationship to the level of energy expenditure for PA levels. Mill's test was reliable and accurate for the PA levels. Intertest reliability was poor for the PA levels. Mill's test proved to be accurate based on the ultrasound exam. The pain caused by the tests was not related to the level of energy expenditure.

FACTORS ASSOCIATED WITH BAD OUTCOME IN CONSERVATIVE THERAPY OF LATERAL EPICONDYLITIS

Objectives: Lateral epicondylitis is an overuse syndrome that is one of the most common causes of elbow pain. The aim of this study is to determine the factors associated with bad outcome in conservative treatment of lateral epicondylitis in our population. Methods: Patients who applied to our outpatient clinic with the diagnosis of lateral epicondylitis between August 2020 and August 2021; analyzed retrospectively. 52 patients who were treated conservatively and followed up for at least 12 months were included in the study. Elbow functionality and pain were evaluated with the “Patient-Rated Tennis Elbow Evaluation” (PRTEE) scoring. Occupation of the patients, antidepressant usage, body mass index(BMI), age and smoking were questioned. Results: 7 (13.4%) patients stated that they fully benefited from conservative treatment. 29 patients (55.8%) expressed that they benefited from the treatment, but their complaints continued at low severity. 16 patients (30.8%) said that they did not benefit from the applied conservative treatment. While the mean PRTEE value was 46.57 in women, it was 32.34 in men. It was observed that female gender negatively affected clinical scores (p=0.004). Mean PRTEE score was 48.31 in physically active manual workers and 31.61 in desk workers (p=0.006). While the mean PRTEE value was 52.81 in patients using antidepressants, this value was 35.6 in patients not using antidepressants (p=0.037). No correlation was found between BMI and PRTEE scores by using Spearman correlation test. Conclusions: Female gender, being a manual worker and using antidepressant medication are associated with poor outcomes in the conservative treatment of lateral epicondylitis.

Title: How should we use corticosteroids in lateral epicondylitis? Local injection or phonophoresis? Running title: Corticosteroid use in lateral epicondylitis

Objective: This study, it was aimed to compare and evaluate the effectiveness of local corticosteroid injection and corticosteroid phonophoresis on grip strength, functional status, pain, and quality of life in lateral epicondylitis. Materials and Methods: Patients with a diagnosis of lateral epicondylitis who underwent corticosteroid phonophoresis or local corticosteroid injection were included in the study. Patients were grouped according to the treatment they received. In the first group, corticosteroid phonophoresis was applied to the lateral epicondyle region using a continuous mode ultrasonic at 1.0 W/cm2 and 1mHz dose with 0.1% betamethasone valerate cream as a conductive agent. In the second group, corticosteroid and local anesthetic injections were applied to the lateral epicondyle region. Two groups received the supervised exercise program. Before treatment and two weeks after treatment, visual analog scale, muscle strength, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand scores, and Nothingom Health Profile results for both groups were recorded from patient files and compared. Results: A total of 43 patients (23 phonophoresis, 20 corticosteroid injections) were enrolled. Although the pain, function, and quality of life of patients improved significantly with both groups, no significant difference was recorded between the groups. Grip and palmar pinch strength significantly increased in only the phonophoresis group. In addition, changing of grip and palmar pinch strength was significantly better in the phonophoresis group than in the corticosteroid injection group. Conclusion: It was determined that corticosteroid administration via phonophoresis instead of injection was more beneficial in terms of grip and palmar pinch strength.

Lateral Epikondilit Hastalarında Günlük Yaşam Aktivite Problemlerinin Belirlenmesi ve Ağrı ile Algılanan Aktivite Performansı ve Memnuniyet İlişkisinin İncelenmesi

Aim: Lateral epicondylitis is one of the most common diseases in the upper extremity that causes pain in the elbow, negatively affects activities of daily living. This study was planned to determine the activities of daily living in adults with lateral epicondylitis and to examine the relationship between pain and perceived occupational performance and satisfaction in activities of daily living.
 Materials and methods: A total of 56 individuals with a diagnosis of lateral epicondylitis, 17 males and 39 females, with a mean age of 52,18±5,92 years, completed the study. Visual Analogue Scale (VAS) was used to evaluate pain, and Canadian Occupational Performance Measure (COPM) was used to determine perceived occupational performance and satisfaction level.
 Results: According to the VAS, the mean pain at rest of the participants was 2,40±0,72, and the mean of pain during activity was 6,14±1,11. According to COPM, the perceived occupational performance mean of the participants in activities of daily living was 4,13±1,04 and the mean satisfaction was 4,07±1,17. When the correlation between pain and activities of daily living was examined, there was no correlation between pain at rest and perceived occupational performance (r=-0,015, p=0,911) and satisfaction (r=-0,064, p=0,639). A moderately strong negative was found between pain during activity and perceived occupational performance (r=-0,729, p

Anatomy and Sonographic Examination for Lateral Epicondylitis: EURO-MUSCULUS/USPRM Approach.

The aim of the study is to define a standardized comprehensive sonographic approach for evaluating the different histoanatomical compartments of the lateral elbow. 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. 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. 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.

Ultrasound-Guided Injection Approach of Treating Tennis Elbow and Elbow Joint Synovitis Simultaneously Under One Needle Insertion Point.

A 52-yr-old man with right elbow pain for 6 mos visited an outpatient rehabilitation clinic. An obvious tender spot at the lateral epicondyle area was palpated with positive Cohen test.1 The patient had received autologous platelet-rich plasma injection but without much improvement.2 Musculoskeletal ultrasound images revealed thickening of the common extensor tendon, combined with diffuse heterogeneity and focal hypoechogenicity. Bony irregularity was observed at the tendon insertion site. The diagnosis of lateral epicondylitis, also known as “tennis elbow,” is a common cause of elbow pain. The exact pathogenesis remains elusive and is often difficult to treat. Ultrasound-guided injection to the bone and common extensor tendon interface may not be effective as many patients are also bothered with elbow joint synovitis.3 As a result, this article describes an important ultrasound-guided injection approach to treat tennis elbow and joint synovitis simultaneously under one needle insertion point. When applying ultrasound-guided injection to treat tennis elbow, the elbow is flexed at a 90-degree angle. The ultrasound linear probe is placed over the lateral epicondyle, along the longitudinal axis of the common extensor tendon origin. Under this sonographic view, the common extensor tendon, the lateral epicondyle, and the elbow joint can be observed. Conventionally, injection can be done under the longitudinal view, in a distal-to-proximal or proximal-to-distal direction, by guiding the needle to the bone tendon (extensor carpi radialis brevis tendon) interface.4 For patients who are also bothered with elbow joint synovitis, simultaneous injection to the bone-tendon interface, and aspiration of the joint fluid followed by the injection of an injectant may be needed (Figs. 1A, B).3 However, under the in-plane or longitudinal view, needle insertion into the elbow joint can be difficult because of the convex curvature of the radial head (Fig. 1B). Therefore, a different injection approach is recommended. Similar to the conventional method, the linear probe is placed longitudinally on top of the elbow joint. The needle is then inserted in a lateral-to-medial direction under the out-of-plane approach or short-axis view into the elbow joint (Figs. 2A, B). The needle is observed as a hyperechoic dot inside the elbow joint. Aspiration of the joint fluid followed by injection can then be performed. Still under the short-axis view, the needle is retracted and then guided in a slightly obliqued direction to the bone-tendon interface to commence subsequent injection treatment (Figs. 3A, B). Steroid was the injectant used. Elbow pain was greatly improved after the treatment.FIGURE 1: A, The linear ultrasound transducer is placed longitudinally on top of the right elbow to visualize the lateral epicondyle, common extensor tendon, bone-tendon (extensor carpi radialis brevis) interface, and the elbow joint. Conventionally, injection can be done under the longitudinal view and in a distal-to-proximal direction by guiding the needle to the bone-tendon interface. B, The needle is accurately guided to the bone-tendon (extensor carpi radialis brevis) interface (*). Due to synovitis, increased hypoechogenicity (resembling fluid accumulation) can be observed in the elbow joint (+). Using the distal-to-proximal direction needle approach, insertion into the elbow joint can be difficult because of the convex curvature of the radial head.FIGURE 2: A, With the linear ultrasound transducer placed longitudinally on top of the right elbow, the needle is inserted in a short-axis or out-of-plane view relative to the transducer and guided into the elbow joint (pink area). B, Under the short-axis view, the injection needle can be visualized as a hyperechoic dot inside the elbow joint.FIGURE 3: A, After completing elbow joint injection, the needle is then retracted and the syringe is moved slightly in a distal direction to guide the needle to the lateral epicondylar area (curved white arrow). B, Still under the short-axis view or slightly obliqued short-axis view, the needle is guided to the bone-tendon interface.

An evaluation of treatment options for lateral epicondylitis

Aim: Lateral pain in the elbow is a widespread problem in orthopedics and physiotherapy. There are different conservative treatment options available, but there is no consensus on their superiority to each other. The aim of this study was to evaluate the efficacy of three different treatment methods applied to patients followed up with a diagnosis of lateral epicondylitis. Methods: The study included a total of 105 patients who were diagnosed with lateral epicondylitis between 2010 and 2016 and treated conservatively. The patients were separated into three groups according to the treatment administered. In Group 1 (n:28), 1 ml betamethasone dipropionate (Diprospan®, Schering-Plough Corp., Kenilworth, NJ, ABD) was applied with the peppering method. In Group 2 (n:28), the same peppering method was used to apply 1 ml local anesthetic (prilocaine hydrochloride, Citanest®, AstraZeneca plc., London, UK). In Group 3 (n:49), extracorporeal shockwave therapy (ESWT) treatment was performed. Data were evaluated before and at one, three, and six months after treatment. Clinical scores were evaluated according to the Quick Dash (Q-DASH, Quick disabilities of arm, shoulder, and hand) scoring system and VAS (visual analog scale) scores during the daily activities of the patients. Quality of life and patient satisfaction levels were evaluated based on Quick Dash scores. Results: A significant improvement was observed in all three methods in the VAS and quality of life of the patients at one, three, and six months after treatment compared to pre-treatment values (P<0.001). A higher level of patient satisfaction was determined in Groups one and two compared to the ESWT group (P<0.001). Conclusion: Significant rates of satisfaction were determined in all three methods, and the corticosteroid treatment administered with the peppering method was not superior over local anesthetic applied with the same method. Although ESWT was beneficial, it was less effective than the other methods and cost higher.

A study on management of tennis elbow by local platelet rich plasma injection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lateral epicondylitis (tennis elbow), a familiar term used to describe myriad symptoms around the lateral aspect of the elbow can occur during activities that require repetitive supination and pronation of the forearm with the elbow in near full extension. This condition can cause severe discomfort to the patient resulting in debilitation and impairment of routine activities. The purpose of this study was to evaluate the effectiveness of local autologous platelet rich plasma injection in the treatment of tennis elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study conducted on 50 patients of either sex with an average age of 45.92 years, presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, NUH, Haryana between November 2016 and February 2018, with a diagnosis of lateral epicondylitis. All the patients were treated with local platelet rich plasma injection and the results were analysed through the assessment of visual analog score (VAS) and disability of arm shoulder and hand (DASH) score. The patients were followed up for a period of 6 months after the local injection of platelet rich plasma.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of the patients had significant relief with this method. The VAS and DASH score improved from the pre-treatment values of 8.7 and 74.6 to 2.6 and 29.8 respectively, which was found to be statistically significant (p&amp;lt;0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus results of our study demonstrate that the local injection of platelet rich plasma is a safe and effective method of treatment of lateral epicondylitis.&lt;/p&gt;

The Role of Elbow Tender Point Examination in the Diagnosis of Lateral Epicondylitis.

To quantify sensitivity and specificity of the tender points and demonstrate how variability in case definition impacts prevalence of lateral epicondylitis (LE). Baseline data analyzed from 1216 workers from the WISTAH study, a multicenter prospective cohort study of upper extremity musculoskeletal disorders. All workers completed computerized questionnaires, structured interviews, and two independent physical examinations in accordance with an established protocol. The prevalence of LE differed based on case definition ranging from 4.7% to 12.1%. Sensitivity was low for tender points 1 to 4 ranging from 6.8% to 34.6%. Specificity was high for tender points 1 to 4 ranging from 95.2% to 97.9%. The prevalence of lateral epicondylitis differs markedly based on case definition used, ranging more than two-fold. Standardization of a case definition is essential to allow for comparisons across studies.

Performance of PROMIS Global-10 to Legacy Instruments in Patients With Lateral Epicondylitis

To validate the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 for patients who have lateral epicondylitis requiring surgical treatment in comparison with other gold standard patient-reported outcomes. Sixty-two patients with lateral epicondylitis of the elbow were prospectively enrolled before arthroscopic treatment. Inclusion criteria were patients 18years of age or older with a diagnosis of lateral epicondylitis. Each patient completed the PROMIS Global-10, EuroQol 5 Dimension (EQ-5D), American Shoulder and Elbow Surgeons (ASES) assessment form, Mayo Elbow Performance Score (MEPS), and Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH). Spearman correlations were calculated. Bland-Altman agreement tests were conducted between estimated EQ-5D scores from the PROMIS-10 and actual EQ-5D scores. Correlation between the PROMIS-10 and the EQ-5D was excellent (0.72, P < .0001). Bland-Altman 95% limits of agreement for estimated EQ-5D scores ranged from 0.33 below to 0.21 above actual EQ-5D scores. Correlation of the PROMIS-10 physical score was good to excellent with MEPS (0.61, P < .0001) and QuickDASH scores (0.64, P < .0001) and good with the ASES (0.58, P < .0001). Correlation of the PROMIS mental scores was good with QuickDASH (0.50, P < .0001) and poor with ASES (0.26, P=.0492) and MEPS (0.37, P= .0038). The PROMIS Global-10 physical scores showed good to excellent correlation with gold standard patient-reported outcome instruments, demonstrating it is a reliable tool for outcome assessment in populations with lateral epicondylitis. Despite the excellent correlation with the EQ-5D, the 95% limit of agreement and high variability among the estimated EQ-5D scores derived from the PROMIS-10 suggests that the PROMIS-10 cannot be used as a substitute for actual EQ-5D scores to derive quality-adjusted life years for economic evaluations and cost-effectiveness research. Level II, development of diagnostic criteria on the basis of consecutive patients.

The application of mechanical diagnosis and therapy in lateral epicondylalgia

Background: lateral epicondylalgia (LE) is a musculoskeletal diagnosis that causes pain and dysfunction in the lateral aspect of the elbow. Mechanical diagnosis and therapy (MDT) is an orthopaedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movement. There has been no investigation of the association between MDT and patients diagnosed with LE.Case description: this report presents three patients matching the currently accepted diagnostic criteria for LE, two with a diagnosis of lateral epicondylitis (tennis elbow) from a medical doctor. These patients were classified and treated by a diplomat of MDT and two third-year doctoral students of physical therapy using MDT.Outcomes: short- and long-term (one year) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in 3–6 visits between 11–59 days. Patients demonstrated the ability to prevent and manage reoccurrence of symptoms independently without seeking further health care.Discussion: this case series raises questions about whether or not the pathologies traditionally associated with the aetiology of LE are actually at fault. Moreover, it raises questions about the utility of special tests typically utilized to identify those structures. The series provides preliminary evidence that MDT may be capable of providing effective short- and long-term outcomes in the management of LE. Level of Evidence: 4

Advances in Upper Extremity Musculoskeletal Ultrasound

In this article, we review the recent updates in the use of musculoskeletal ultrasound for the evaluation of pathology involving the upper extremity, including the shoulder, elbow, and wrist. We discuss the value of dynamic ultrasound evaluation in the setting of cubital tunnel syndrome and glenohumeral instability while addressing the emerging concept of the glenoid track. Clinical use of compressive sonoelastography will be introduced with emphasis on its utility in the diagnosis of lateral epicondylitis and carpal tunnel syndrome. Through the course of this discussion, we will touch upon future research topics and challenges to clinical implementation.

English

The aim of the present study was to analyze the diagnostic accuracy of the commonly used provocative tests in the diagnosis of lateral epicondylitis (LE). Cozen’s test, Mills test and Maudsley test are most widely used. Till date no studies have been reported on the diagnostic accuracy of these tests. Musculoskeletal ultrasonography serves as a gold standard tool in the diagnosis of LE. Thirty subjects participated in the study. Baseline measurements of pain severity, elbow joint mobility, hand grip strength and three provocative tests were recorded by the principal investigator. A second investigator accompanied the subjects for musculoskeletal ultrasonography who was blinded of the test results. The thickness of common extensor tendon, echo texture and lateral epicondyle bony contour was measured. The test results of the three provocative tests with ultrasonographic findings were analyzed. The sensitivity for Cozen’s test, Maudsley test and Mills test was found to be 84%, 88% and 53% respectively. The specificity for Cozen’s Maudsley and Mills test was found to be 0%, 0% and 100% respectively. Mills test showed significant area under receiver operator curve (ROC) i.e. (0.769), which explains that the test has good diagnostic accuracy. This validation study, concludes that Mills test has an excellent diagnostic value for ruling in LE.

Prevalence and risk factors of lateral epicondylitis in a mountain village in Japan.

To determine the prevalence and risk factors of lateral epicondylitis in a mountain village in Japan. 176 men and 246 women aged 24 to 86 (mean, 61) years from a mountain village in Japan underwent regular medical examination and completed a self-administered questionnaire with items related to gender, weight, height, dominant hand, heaviness of labour (no job, light, intermediate, and heavy), presence of elbow pain 2 weeks before examination, and smoking and drinking experience. The diagnosis of lateral epicondylitis was based on self-reported symptoms and clinical signs. The prevalence of lateral epicondylitis in a mountain village in Japan was 3.8% (95% confidence interval [CI], 2.2%-6.1%). Of the 422 subjects, 47 had elbow pain and 16 of them were diagnosed to have definite lateral epicondylitis. 15 of them were right-handed and had involvement of the left (n=8) and right (n=7) sides; the remaining one was left-handed and had involvement of the left side. The dominant hand was not associated with the affected side (p=1.00). Heaviness of labour was not associated with the elbow pain scores. The prevalence was highest in subjects aged 50 to 59 years (9% [95% CI, 3.8%-17.1%]) and those with no job (14% [95% CI, 1.1%-44.1%]). Lateral epicondylitis was not associated with gender, age, body mass index, dominant hand, heaviness of labour, smoking, or drinking.

Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis.

OBJECTIVE:Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis.METHODS:A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed.RESULTS:Visual analog scale (VAS) scores were significantly lower (p<0.05) and grip strength significantly increased (p<0.05) one month after ESWT treatment. Overall PRTEE-T survey scores decreased significantly at first month (p<0.001) after treatment. Patient’s and physician’s global self-assessment scores were significantly lower after treatment (p<0.05).CONCLUSION:To conclude, ESWT utilization in conservative treatment of lateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.

The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial

This study seeks to compare two treatment methods of lateral epicondylitis: corticosteroid injection (CSI) and a local anesthetic injection (LAI). In this single-blinded randomized clinical trial, 138 patients with the diagnosis of lateral epicondylitis were assigned either into CSI group receiving methylprednisolone 1 ml (49 patients) or LAI group (51 patients) receiving procaine 1 ml 2 % in a single dose at the maximal point tenderness site. The primary outcome measure was elbow disability using Quick DASH, and secondary outcome measures were pain intensity using Visual Analogue Scale (VAS) and recurrence rate at pretreatment visit and at 3-, 6- and 12-week post-treatment visits. There were no significant differences between the patients in both groups for demographic factors including age, gender, dominant hand, involved hand, and work pressure. Before treatment, the patients in both groups were suffering from the same rates of elbow disability and pain as measured by Quick DASH and VAS, respectively, (p > 0.05). In general, the recovery rate (comparison between pretreatment visit and last post-treatment visit) was significantly more effective and higher in CSI than LAI. CSI was dramatically more effective at 3-week visit, but less and less effective at 6- and 12-week visits. At 12-week visit the recurrence rate was 34.7 % (17 patients) in CSI group. For lateral epicondylitis, CSI has the best short-term treatment results yet the highest recurrent rates. The combination of CSI with other treatment option or with a change in injection technique from single injection to peppering injection may be promising.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.

Utility of Sonographic Measurement of the Common Tensor Tendon in Patients With Lateral Epicondylitis

The purpose of this article is to evaluate prospectively the utility of sonographic measurements of the common extensor tendon for diagnosing lateral epicondylitis. Forty-eight patients with documented lateral epicondylitis and 63 healthy volunteers were enrolled and underwent ultrasound of the elbow joint. The common extensor tendon overlying the bony landmark was scanned transversely, and the cross-section area and the maximum thickness were measured. Clinical examination was used as the reference standard in the diagnosis of lateral epicondylitis. Data from the patient and control groups were compared with established optimal diagnostic criteria for lateral epicondylitis using receiver operating characteristic curves. Qualitative evaluation with grayscale ultrasound was also performed on patients and healthy volunteers. The common extensor tendon was significantly thicker in patients with lateral epicondylitis than in control subjects (p < 0.01). Tendon thickness greater than 4.2 mm (sensitivity, 78.4%; specificity, 95.2%; accuracy, 87.7%) and area larger than or equal to 32 mm(2) (sensitivity, 86.3%; specificity, 82.5%; accuracy, 84.2%) were highly predictive of lateral epicondylitis. For qualitative evaluation with gray-scale ultrasound, overall sensitivity, specificity, and accuracy values in the diagnosis of lateral epicondylitis were 76.5%, 76.2%, and 76.3%, respectively. The quantitative sonographic measurements had an excellent diagnostic performance for lateral epicondylitis, as well as good or excellent interreader agreement. A common extensor tendon cross-section area greater than or equal to 32 mm(2) and a thickness of 4.2 mm correlated well with the presence of lateral epicondylitis. However, further prospective study is necessary to determine whether quantitative ultrasound with these cutoff values can improve the accuracy of the diagnosis of lateral epicondylitis.

Simple overlay device for determining radial head and neck height

The purpose of this study was to test the hypothesis that a simple overlay device can be used on radiographs to measure radial head and neck height. Thirty anteroposterior elbow radiographs from 30 patients with a clinical diagnosis of lateral epicondylitis were examined to measure radial head and neck height. Three methods using different points along the bicipital tuberosity as a landmark were used. Method 1 used the proximal end of the bicipital tuberosity, method 2 used the most prominent point of the bicipital tuberosity, and method 3 used a simple overlay device (SOD) template that was aligned with anatomic reference points. All measurements were performed three times by three observers to determine interobserver and intraobserver reliability. Intraclass correlation coefficients revealed higher interobserver and intraobserver correlations for the SOD template method than for the other two methods. The 95% limits of agreement between observers were markedly better (-1.8 mm to +1.0 mm) for the SOD template method than for the proximal point method (-3.8 mm to +3.4 mm) or the prominent point method (-5.9 mm to +4.9 mm). We found that the SOD template method was reliable for assessing radial head and neck height. It had less variability than other methods, its 95% limit of agreement being less than 2 mm. This method could be helpful for assessing whether or not the insertion of a radial head prosthesis has resulted in over-lengthening of the radius.