Andrew Wyn Clarke MBChB, Presenter: Nothing to Disclose

David Alister Connell MBBS, Abstract Co-Author: Nothing to Disclose

To identify sonographic predictors for tendon healing in patients with lateral elbow tendinopathy by correlating initial ultrasound findings with changes in pain and functional disability scores.

Patients: Sixty-two elbows (34 right, 28 left) in sixty-two patients (30 male, 32 female) with a clinical diagnosis of lateral elbow tendinopathy underwent sonographic evaluation of the common extensor origin after assessment with a validated outcome measure. Technique: High frequency linear sonographic assessment of five criteria: hypoechogenecity, intrasubstance tear, lateral collateral ligament (LCL) tear, overall tendon thickness and neovascularity. Intervention: Six months of conservative standardised treatment (physiotherapy with eccentric loading). Outcome Measures: Pain severity and functional disability assessment using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, a validated outcome measure rated out of 150 points. After six months of conservative standardised treatment the PRTEE questionnaire was repeated.  

The mean age of patients was 43 (range 25 - 61). Mean pre treatment PRTEE was 117 (range 77 - 146) and post treatment 43 (0 -136). This difference in means was found to be significant (p < 0.0001). 17 patients (27%) had little change in symptoms represented by a change in PRTEE of less than 40, mean change in PRTEE -74 (range -137 to 30).  In the patients who showed improvement 38 of 45 (84%) had tears, with a lower mean size of 4 mm.  A positive correlation was identified between post treatment PRTEE and pre- treatment PRTEE (p<0.05) , presence of LCL tear (p <0.001) and size of the largest intrasubstance tear (p<0.0001).  A negative correlation was identified with amount of hypoechogenecity. No correlation was found with age, sex, side, duration of symptoms, thickness of tendon or amount of neovascularity.

The size of intrasubstance tear, amount of hypoechogenecity and presence of an LCL tear on ultrasound can be used to assess lateral epicondylitis severity, to guide treatment and assess response. Presence of neovascularity has little correlation with change in pain severity or functional disability and may be a poor prognostic indicator.

This study suggests that ultrasound findings of intrasubstance or lateral collateral ligament tears have the most clinical relevance. Treatment should be directed at healing tendon tears.

Clarke, A, Connell, D, Lateral Elbow Tendinopathy: Correlation of Ultrasound Findings with Pain and Functional Disability.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014158.html