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

Department of Radiology, McMaster University, Hamilton, ON, Canada.
Skeletal Radiology (Impact Factor: 1.51). 12/2011; 41(4):369-86. DOI: 10.1007/s00256-011-1343-8
Source: PubMed


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.

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    • "Patients with cervical radiculopathy, proximal neurovascular entrapment and radial tunnel syndrome [2] may complain of the same symptoms as patients with LE. However, there is no “gold standard” for the diagnosis of LE, and orthopaedic tests such as pain with resisted wrist extension (Cozen’s sign) are traditionally recommended for differential diagnosis [22]. "
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    ABSTRACT: Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments.The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE. Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel. Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8). A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.
    BMC Musculoskeletal Disorders 10/2013; 14(1):310. DOI:10.1186/1471-2474-14-310 · 1.72 Impact Factor
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    • "On MRI, Panner disease manifests as abnormal T2 hyperintensity and T1 hypointensity in a geographic region of the capitellum (Figure 7). Although it progresses to sclerosis and fragmentation (readily appreciated on radiographs), the prognosis is usually good.25,27 OCD, by contrast, is an acquired focal lesion of bone and cartilage, most often affecting the capitellum, and felt to be related to repetitive valgus stress as seen in young competitive athletes. "
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    ABSTRACT: Context: The elbow is a complex joint and commonly injured in athletes. Evaluation of the elbow by magnetic resonance imaging (MRI) is an important adjunct to the physical examination. To facilitate accurate diagnosis, a concise structured approach to evaluation of the elbow by MRI is presented. Evidence acquisition: A PubMed search was performed using the terms elbow and MR imaging. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the MRI appearance of normal anatomy and common pathology of the elbow. Results: The spectrum of common elbow disorders varies from obvious acute fractures to chronic overuse injuries whose imaging manifestations can be subtle. MRI evaluation should include bones; lateral, medial, anterior, and posterior muscle groups; the ulnar and radial collateral ligaments; as well as nerves, synovium, and bursae. Special attention should be paid to the valgus extension overload syndrome and the MRI appearance of associated injuries when evaluating throwing athletes. Conclusion: MRI evaluation of the elbow should follow a structured approach to facilitate thoroughness, accuracy, and speed. Such an approach should cover bone, cartilage, muscle, tendons, ligaments, synovium, bursae, and nerves.
    Sports Health A Multidisciplinary Approach 01/2013; 5(1):34-49. DOI:10.1177/1941738112467941
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    ABSTRACT: Objective: To describe imaging findings in patients with synovial fringe (SF) syndrome of the elbow and to compare with a control population. Materials and methods: Nine patients (5 men, 4 women) whose mean age was 35.7 years were diagnosed with SF syndrome and had undergone preoperative elbow MRI. The radiohumeral (RH) plica was assessed for thickness, cross-sectional area, coverage of one third or more of the radial head, blunting of the free edge, and T2 signal intensity abnormality. Other abnormalities of the RH joint were also assessed, including adjacent articular cartilage defects, subcortical bone marrow signal abnormality in the capitellum, and synovitis. Results were compared with 15 control patients who were asymptomatic laterally and posteriorly. Results: Mean thickness and cross-sectional area of the RH plica were 1.8 mm and 19.4 mm(2) respectively in controls, compared with 2.5 mm and 21.9 mm(2) respectively in symptomatic patients. No statistically significant differences in the distribution of the mean thickness or cross-sectional area of the RH plica were found between the two groups. However, 67% of SF syndrome patients had a RH plica thickness greater than 2.6 mm compared with only 13% of controls (p = 0.021). Other abnormalities of the RH plica occurred more frequently in patients with SF syndrome compared with controls, but were not statistically significant. Conclusion: In patients presenting with posterolateral pain or mechanical symptoms in the elbow, RH plica thickness greater than 2.6 mm on elbow MRI examinations may help identify patients with SF syndrome.
    Skeletal Radiology 09/2012; 42(5). DOI:10.1007/s00256-012-1523-1 · 1.51 Impact Factor
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