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Real-Time Sonoelastography of Lateral Epicondylitis: Comparison of Findings Between Patients and Healthy Volunteers

¹ Department of Radiology II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
² Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria.
³ Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —32-year-old healthy volunteer with normal extensor tendons. Longitudinal ultrasound (A, C, and E) and real-time sonoelastographic (B, D, and F) scans show normal anterior third (A and B), middle third (C and D), and posterior third (E and F) of common extensor tendon. Elasticity spectrum was between red, representing soft tissue, and blue, representing hard tissue. Ultrasound findings of normal tendons were those of hard tissue (stars) on real-time sonoelastographic images. Surrounding tissue can be appreciated as having soft structure but clearly discernible from tendon. Bony artifact shown as red areas inside bone are present on all real-time sonoelastographic images. r = radial head, lat. epi. = lateral epicondyle.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —32-year-old healthy volunteer with normal extensor tendons. Longitudinal ultrasound (A, C, and E) and real-time sonoelastographic (B, D, and F) scans show normal anterior third (A and B), middle third (C and D), and posterior third (E and F) of common extensor tendon. Elasticity spectrum was between red, representing soft tissue, and blue, representing hard tissue. Ultrasound findings of normal tendons were those of hard tissue (stars) on real-time sonoelastographic images. Surrounding tissue can be appreciated as having soft structure but clearly discernible from tendon. Bony artifact shown as red areas inside bone are present on all real-time sonoelastographic images. r = radial head, lat. epi. = lateral epicondyle.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —32-year-old healthy volunteer with normal extensor tendons. Longitudinal ultrasound (A, C, and E) and real-time sonoelastographic (B, D, and F) scans show normal anterior third (A and B), middle third (C and D), and posterior third (E and F) of common extensor tendon. Elasticity spectrum was between red, representing soft tissue, and blue, representing hard tissue. Ultrasound findings of normal tendons were those of hard tissue (stars) on real-time sonoelastographic images. Surrounding tissue can be appreciated as having soft structure but clearly discernible from tendon. Bony artifact shown as red areas inside bone are present on all real-time sonoelastographic images. r = radial head, lat. epi. = lateral epicondyle.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —32-year-old healthy volunteer with normal extensor tendons. Longitudinal ultrasound (A, C, and E) and real-time sonoelastographic (B, D, and F) scans show normal anterior third (A and B), middle third (C and D), and posterior third (E and F) of common extensor tendon. Elasticity spectrum was between red, representing soft tissue, and blue, representing hard tissue. Ultrasound findings of normal tendons were those of hard tissue (stars) on real-time sonoelastographic images. Surrounding tissue can be appreciated as having soft structure but clearly discernible from tendon. Bony artifact shown as red areas inside bone are present on all real-time sonoelastographic images. r = radial head, lat. epi. = lateral epicondyle.

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —32-year-old healthy volunteer with normal extensor tendons. Longitudinal ultrasound (A, C, and E) and real-time sonoelastographic (B, D, and F) scans show normal anterior third (A and B), middle third (C and D), and posterior third (E and F) of common extensor tendon. Elasticity spectrum was between red, representing soft tissue, and blue, representing hard tissue. Ultrasound findings of normal tendons were those of hard tissue (stars) on real-time sonoelastographic images. Surrounding tissue can be appreciated as having soft structure but clearly discernible from tendon. Bony artifact shown as red areas inside bone are present on all real-time sonoelastographic images. r = radial head, lat. epi. = lateral epicondyle.

View larger version (48K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —32-year-old healthy volunteer with normal extensor tendons. Longitudinal ultrasound (A, C, and E) and real-time sonoelastographic (B, D, and F) scans show normal anterior third (A and B), middle third (C and D), and posterior third (E and F) of common extensor tendon. Elasticity spectrum was between red, representing soft tissue, and blue, representing hard tissue. Ultrasound findings of normal tendons were those of hard tissue (stars) on real-time sonoelastographic images. Surrounding tissue can be appreciated as having soft structure but clearly discernible from tendon. Bony artifact shown as red areas inside bone are present on all real-time sonoelastographic images. r = radial head, lat. epi. = lateral epicondyle.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Findings in patients. All alterations (arrow) on ultrasound images (A, C, and E) appear as areas of softening on real-time sonoelastographic images (B, D, and F). All images are longitudinal scans. lat. epi. = lateral epicondyle, r = radial head. 41-year-old woman with intratendinous tendinopathy.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Findings in patients. All alterations (arrow) on ultrasound images (A, C, and E) appear as areas of softening on real-time sonoelastographic images (B, D, and F). All images are longitudinal scans. lat. epi. = lateral epicondyle, r = radial head. 41-year-old woman with intratendinous tendinopathy.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Findings in patients. All alterations (arrow) on ultrasound images (A, C, and E) appear as areas of softening on real-time sonoelastographic images (B, D, and F). All images are longitudinal scans. lat. epi. = lateral epicondyle, r = radial head. 27-year-old man with partial tear.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Findings in patients. All alterations (arrow) on ultrasound images (A, C, and E) appear as areas of softening on real-time sonoelastographic images (B, D, and F). All images are longitudinal scans. lat. epi. = lateral epicondyle, r = radial head. 27-year-old man with partial tear.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —Findings in patients. All alterations (arrow) on ultrasound images (A, C, and E) appear as areas of softening on real-time sonoelastographic images (B, D, and F). All images are longitudinal scans. lat. epi. = lateral epicondyle, r = radial head. 47-year-old man with large area of tendinopathy and involvement of superficial structures.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —Findings in patients. All alterations (arrow) on ultrasound images (A, C, and E) appear as areas of softening on real-time sonoelastographic images (B, D, and F). All images are longitudinal scans. lat. epi. = lateral epicondyle, r = radial head. 47-year-old man with large area of tendinopathy and involvement of superficial structures.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Comparison of normal and abnormal findings. r = radial head, lat. epi. = lateral epicondyle. 26-year-old healthy volunteer. Longitudinal ultrasound (A) and real-time sonoelastographic (B) images show radial collateral ligament (arrow). B shows hard ligamentous tissue and small area of softening at insertion of common extensor tendon.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Comparison of normal and abnormal findings. r = radial head, lat. epi. = lateral epicondyle. 26-year-old healthy volunteer. Longitudinal ultrasound (A) and real-time sonoelastographic (B) images show radial collateral ligament (arrow). B shows hard ligamentous tissue and small area of softening at insertion of common extensor tendon.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Comparison of normal and abnormal findings. r = radial head, lat. epi. = lateral epicondyle. 26-year-old woman with abnormal ligament. Longitudinal ultrasound scan (C) shows no alteration in radial collateral ligament (arrow), but real-time sonoelastographic image (D) shows ligament (arrow) is soft.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Comparison of normal and abnormal findings. r = radial head, lat. epi. = lateral epicondyle. 26-year-old woman with abnormal ligament. Longitudinal ultrasound scan (C) shows no alteration in radial collateral ligament (arrow), but real-time sonoelastographic image (D) shows ligament (arrow) is soft.

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