Sonographic examination of lateral epicondylitis

OBJECTIVE, The purpose of this study was to describe the sonographic appear ance of the common extensor origin in cadavers and asymptomatic volunteers. and to relate this appearance to the findings in patients with lateral epi condylitis. SUBJECTS AND METHODS. Seventy-two elbows in 71 patients with lateral epicon dylitis were examined on sonography, Most of the patients (60/71) gave a hi story of repetitive microtrauma, The injuries were evaluated with respect t o location and severity. Focal areas of degeneration, discrete cleavage tea rs, and involvement of the lateral collateral ligament were identified. Cal cification and bony changes were noted. The appearance of the normal common extensor tendon was described, and cadaveric specimens were dissected. Twe nty-one patients subsequently underwent surgery. RESULTS, The normal common extensor origin is composed of longitudinal fibr ils bound closely with the extensor carpi radialis brevis constituting most of the deep fibers, with the extensor digitorum making up the superficial part. The lateral collateral ligament can he identified as a discrete and s eparate band. The most common appearance of lateral epicondylitis is a foca l hypoechoic area in the deep part of the tendon (46/72). These focal areas were identified at surgery and corresponded histologically to collagen deg eneration with fibroblastic proliferation. Often discrete cleavage planes t raversing the tendon were manifest as partial (18/72) and complete (2/72) t ears. The lateral collateral ligament was involved in eight of 72 elbows. CONCLUSION. Sonography of the common extensor origin can be used to confirm lateral epicondylitis in patients with lateral elbow pain and provide info rmation about the severity of the disease.