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Lateral epicondylitis: Associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We assessed the implications of MR imaging with clinical history in lateral epicondylitis management by evaluating imaging and clinical features in patients with lateral epicondylitis treated conservatively or operatively.

Methods

Sixty patients with lateral epicondylitis treated conservatively (n = 38) or operatively (n = 22) from 2011–2015 were included. MR imaging findings of common extensor tendon (CET), lateral collateral ligament (LCL) complex, muscle oedema, ulnar nerve and elbow joint were reviewed. Clinical data recorded were frequency, duration and intensity of pain, history of trauma and injection therapy, range of motion.

Results

MRI-assessed CET and LCL complex abnormalities, muscle oedema, radiocapitellar joint widening, joint effusion/synovitis, pain frequency and intensity differed significantly between the two groups (p < .05) with increased severity in operative group. Persistent pain (OR 12.2, p < .01), CET abnormality on longitudinal plane (OR 7.5, p = .03 for grade 2; OR 22.4, p < .01 for grade 3) and muscle oedema (OR 6.7, p = .03) were major factors associated with operative treatment. Area under the ROC curve of predicted probabilities for combination of these factors was 0.83.

Conclusion

MR imaging, combined with clinical assessment, could facilitate appropriate management planning for patients with lateral epicondylitis.

Key Points

• MRI can reflect different disease severity between patients treated conservatively/operatively.

• CET abnormality, muscle oedema were major MRI findings with operative treatment.

• Patients in operative group were more likely to experience persistent pain.

• MRI plus clinical symptoms could facilitate appropriate management for lateral epicondylitis.

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Abbreviations

AUC:

Area under the curve

CET:

Common extensor tendon

ECRB:

Extensor carpi radialis brevis

FTT:

Full thickness tear

ICC:

Intraclass correlation coefficient

LCL:

Lateral collateral ligament

MR:

Magnetic resonance

PTT:

Partial thickness tear

ROM:

Range of motion

VAS:

Visual analogue scale

References

  1. Calfee RP, Patel A, DaSilva MF, Akelman E (2008) Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg 16:19–29

    Article  PubMed  Google Scholar 

  2. Walz DM, Newman JS, Konin GP, Ross G (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30:167–184

    Article  PubMed  Google Scholar 

  3. Potter HG, Hannafin JA, Morwessel RM, DiCarlo EF, O'Brien SJ, Altchek DW (1995) Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology 196:43–46

    Article  CAS  PubMed  Google Scholar 

  4. Martin CE, Schweitzer ME (1998) MR imaging of epicondylitis. Skelet Radiol 27:133–138

    Article  Google Scholar 

  5. Pfahler M, Jessel C, Steinborn M, Refior H (1998) Magnetic resonance imaging in lateral epicondylitis of the elbow. Arch Orthop Trauma Surg 118:121–125

    Article  CAS  PubMed  Google Scholar 

  6. Pasternack I, Tuovinen E-M, Lohman M, Vehmas T, Malmivaara A (2001) MR findings in humeral epicondylitis: a systematic review. Acta Radiol 42:434–440

    CAS  PubMed  Google Scholar 

  7. Miller TT, Shapiro MA, Schultz E, Kalish PE (2002) Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound 30:193–202

    Article  PubMed  Google Scholar 

  8. Smidt N, Van Der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM (2002) Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 359:657–662

    Article  CAS  PubMed  Google Scholar 

  9. Taylor SA, Hannafin JA (2012) Evaluation and management of elbow tendinopathy. Sports Health: Multidisc App 4:384–393

    Article  Google Scholar 

  10. Ahmad Z, Siddiqui N, Malik S, Abdus-Samee M, Tytherleigh-Strong G, Rushton N (2013) Lateral epicondylitis. Bone Joint J 95:1158–1164

    Article  PubMed  Google Scholar 

  11. Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A (2011) Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med 39:2130–2134

    Article  PubMed  Google Scholar 

  12. Edwards SG, Calandruccio JH (2003) Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am] 28:272–278

    Article  Google Scholar 

  13. Paoloni JA, Appleyard RC, Nelson J, Murrell GA (2003) Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow. Am J Sports Med 31:915–920

    Article  PubMed  Google Scholar 

  14. Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M (2006) Ultrasound-guided autologous blood injection for tennis elbow. Skelet Radiol 35:371–377

    Article  Google Scholar 

  15. Krey D, Borchers J, McCamey K (2015) Tendon needling for treatment of tendinopathy: a systematic review. Phys Sportsmed 43:80–86

    Article  PubMed  Google Scholar 

  16. Burke CJ, Adler RS (2016) Ultrasound-guided percutaneous tendon treatments. AJR Am J Roentgenol 207:495–506

    Article  PubMed  Google Scholar 

  17. Jacobson JA, Kim SM, Brigido MK (2016) Ultrasound-Guided Percutaneous TenotomySeminars in musculoskeletal radiology. Thieme Medical Publishers, pp 414-421

  18. Seng C, Mohan PC, Koh SBJ et al (2016) Ultrasonic percutaneous tenotomy for recalcitrant lateral elbow tendinopathy: sustainability and sonographic progression at 3 years. Am J Sports Med 44:504–510

    Article  PubMed  Google Scholar 

  19. Nirschl RP, Pettrone F (1979) Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 61:832–839

    Article  CAS  PubMed  Google Scholar 

  20. Cohen MS, Romeo AA (2009) Open and Arthroscopic Management of Lateral Epicondylitis in the Athlete. Hand Clin 25:331–338

    Article  PubMed  Google Scholar 

  21. Romeo AA, Pensak M, Nho SJ, Friel NA, Cohen MS, Cole BJ (2010) Arthroscopic treatment of lateral epicondylitis. Tech Should Elbow Surg 11:25–31

    Article  Google Scholar 

  22. Matache BA, Berdusco R, Momoli F, Lapner PL, Pollock J (2016) A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis. BMC Musculoskelet Disord 17:1

    Article  Google Scholar 

  23. Lee MH, Cha JG, Jin W et al (2011) Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. Am J Roentgenol 196:1363–1367

    Article  Google Scholar 

  24. Bauer S, Wang A, Butler R et al (2014) Reliability of a 3 T MRI protocol for objective grading of supraspinatus tendonosis and partial thickness tears. J Orthop Surg Res 9:1

    Article  Google Scholar 

  25. Zoner CS, Buck FM, Cardoso FN et al (2010) Detailed MRI–anatomic study of the lateral epicondyle of the elbow and its tendinous and ligamentous attachments in cadavers. Am J Roentgenol 195:629–636

    Article  Google Scholar 

  26. Stoller DW (2007) Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Lippincott Williams & Wilkins

  27. Roemer F, Javaid MK, Guermazi A et al (2010) Anatomical distribution of synovitis in knee osteoarthritis and its association with joint effusion assessed on non-enhanced and contrast-enhanced MRI. Osteoarthr Cartil 18:1269–1274

    Article  CAS  PubMed  Google Scholar 

  28. Hayashi D, Roemer FW, Katur A et al (2011) Imaging of synovitis in osteoarthritis: current status and outlookSeminars in arthritis and rheumatism. Elsevier 116–130

  29. Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 363–374

  30. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420

    Article  CAS  PubMed  Google Scholar 

  31. Qi L, Zhang YD, Yu RB, Shi HB (2016) Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis: Is There a Relationship Between Magnetic Resonance Imaging Abnormalities of the Common Extensor Tendon and the Patient's Clinical Symptom? Medicine (Baltimore) 95:e2681

    Article  CAS  Google Scholar 

  32. Coel M, Yamada CY, Ko J (1993) MR imaging of patients with lateral epicondylitis of the elbow (tennis elbow): importance of increased signal of the anconeus muscle. AJR Am J Roentgenol 161:1019–1021

    Article  CAS  PubMed  Google Scholar 

  33. Haahr J, Andersen J (2003) Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice. Rheumatology 42:1216–1225

    Article  CAS  PubMed  Google Scholar 

  34. Knutsen EJ, Calfee RP, Chen RE, Goldfarb CA, Park KW, Osei DA (2015) Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis. Am J Sports Med:0363546515590220

  35. Bredella M, Tirman P, Fritz R, Feller J, Wischer T, Genant H (1999) MR imaging findings of lateral ulnar collateral ligament abnormalities in patients with lateral epicondylitis. AJR Am J Roentgenol 173:1379–1382

    Article  CAS  PubMed  Google Scholar 

  36. Lattermann C, Romeo AA, Anbari A et al (2010) Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elb Surg 19:651–656

    Article  Google Scholar 

  37. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M (2009) Elbow Nerves: MR Findings in 60 Asymptomatic Subjects—Normal Anatomy, Variants, and Pitfalls 1. Radiology 252:148–156

    Article  PubMed  Google Scholar 

  38. Rompe JD, Overend TJ, MacDermid JC (2007) Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire. J Hand Ther 20:3–11

    Article  PubMed  Google Scholar 

  39. Housner JA, Jacobson JA, Misko R (2009) Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 28:1187–1192

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Jung Bok Lee, Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, who helped in conducting the statistical analysis.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-738, Korea

    Ji Young Jeon, Min Hee Lee, Hye Won Chung, Sang Hoon Lee & Myung Jin Shin

  2. Department of Radiology, Gachon University, Gil Medical Center, Incheon, Korea

    Ji Young Jeon

  3. Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    In-Ho Jeon

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  1. Ji Young Jeon
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  2. Min Hee Lee
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Correspondence to Min Hee Lee.

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Guarantor

The scientific guarantor of this publication is Min Hee Lee, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Jung Bok Lee, Clinical Epidemiology and Biostatistics, kindly provided statistical advice for this study.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study / observational

• performed at one institution

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Jeon, J.Y., Lee, M.H., Jeon, IH. et al. Lateral epicondylitis: Associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic managements. Eur Radiol 28, 972–981 (2018). https://doi.org/10.1007/s00330-017-5084-5

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  • DOI: https://doi.org/10.1007/s00330-017-5084-5

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