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Sonographic Examination of Lateral Epicondylitis

¹ All authors: Department of Radiology, Victoria House Private Hospital, 316 Malvern Rd., Prahran 3181, Melbourne, Victoria, Australia.

View larger version (80K): [in a new window]   Fig. 1. —18-year-old healthy male volunteer. Longitudinal sonogram shows normal common extensor origin (arrow), characterized by uniform band of tendon fibrils running closely in parallel toward lateral epicondyle (asterisk).

View larger version (98K): [in a new window]   Fig. 2. —31-year-old male professional tennis player who presented with acute onset of right lateral elbow pain. Longitudinal sonogram shows small hypoechoic focus (arrow) in deep fibers of otherwise normal-appearing tendon. Deep fibers are predominantly composed of extensor carpi radialis brevis that can be followed from forearm. Hypoechoic focus was thought to represent area of collagen degeneration and fibroblastic proliferation that was subsequently confirmed at surgery.

View larger version (91K): [in a new window]   Fig. 3. —38-year-old woman with 6-month history of right lateral elbow pain. Longitudinal sonogram reveals large anechoic focus (between asterisks) with no normal fibers intact in mid and deep fibers of common extensor origin where fibers arise from bone. Focus occupied more than 70% of tendon depth and was thought to represent partial tear. Findings were confirmed at surgery.

View larger version (94K): [in a new window]   Fig. 4. —35-year-old male tennis player who presented with left elbow pain. Longitudinal sonogram reveals linear fissures extending obliquely through tendon (small arrows) from deep surface characteristic of partial tearing of common extensor origin (large arrow).

View larger version (80K): [in a new window]   Fig. 5. —53-year-old female chef with 2-year history of chronic lateral elbow pain. Longitudinal sonogram shows linear split (arrows) running in substance of common extensor origin compatible with high-grade partial tear. Tendon is thin and attenuated; however, some fibers were shown to continue to epicondyle. Partial tear was confirmed at surgery.

View larger version (82K): [in a new window]   Fig. 6A. —54-year-old male golfer with 6-month history of left lateral elbow pain. Longitudinal sonogram shows large linear hypoechoic cleft (straight arrows) extending from deep surface through torn attenuated common extensor origin, indicating complete tear. Note tear of lateral collateral ligament (curved arrow) and humerus (asterisk).

View larger version (89K): [in a new window]   Fig. 6B. —54-year-old male golfer with 6-month history of left lateral elbow pain. Longitudinal sonogram of lateral collateral ligament shows complete disruption (arrow) of radial attachment. Complete tear of common extensor origin and lateral collateral ligament was confirmed at surgery. Note radial head (asterisk).

View larger version (87K): [in a new window]   Fig. 7. —56-year-old male carpenter with lateral epicondylitis. Longitudinal sonogram shows diffuse thickened hypoechoic tendon (between asterisks) with loss of normal fibrillar pattern compatible with diffuse tendinopathy.

View larger version (90K): [in a new window]   Fig. 8A. —45-year-old male weight lifter with bilateral elbow pain. Longitudinal sonogram shows large hypoechoic focus (arrow) in deep fibers of right common extensor origin characteristic of severe tendinopathy.

View larger version (99K): [in a new window]   Fig. 8B. —45-year-old male weight lifter with bilateral elbow pain. Sonogram taken obliquely through focus of tendinopathy of same elbow as A shows two foci of calcification (arrows).

View larger version (95K): [in a new window]   Fig. 8C. —47-year-old male weight lifter with bilateral elbow pain. Longitudinal sonogram of left common extensor origin shows mild diffuse tendinopathy and cortical bone spur (arrow).

View larger version (92K): [in a new window]   Fig. 9A. —29-year-old female volleyball player with 5-week history of left elbow pain. Longitudinal sonogram shows hypoechoic focus (arrow, between asterisks) in most superficial fibers of common extensor origin where it abuts bony interface. This part of tendon consists predominantly of extensor digitorum. Deep fibers are preserved.

View larger version (108K): [in a new window]   Fig. 9B. —29-year-old female volleyball player with 5-week history of left elbow pain. Transverse sonogram shows anechoic focus (between asterisks) affecting mid fibers of superficial part of tendon. Imaging in two planes confirms finding and helps to exclude artifact due to anisotropy.

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