Skeletal Radiology

, Volume 41, Issue 1, pp 83–89 | Cite as

Reliability of sonographic assessment of tendinopathy in tennis elbow

  • Leon Poltawski
  • Syed Ali
  • Vijay Jayaram
  • Tim Watson
Scientific Article



To assess the reliability and compute the minimum detectable change using sonographic scales to quantify the extent of pathology and hyperaemia in the common extensor tendon in people with tennis elbow.

Materials and methods

The lateral elbows of 19 people with tennis elbow were assessed sonographically twice, 1–2 weeks apart. Greyscale and power Doppler images were recorded for subsequent rating of abnormalities. Tendon thickening, hypoechogenicity, fibrillar disruption and calcification were each rated on four-point scales, and scores were summed to provide an overall rating of structural abnormality; hyperaemia was scored on a five point scale. Inter-rater reliability was established using the intraclass correlation coefficient (ICC) to compare scores assigned independently to the same set of images by a radiologist and a physiotherapist with training in musculoskeletal imaging. Test-retest reliability was assessed by comparing scores assigned by the physiotherapist to images recorded at the two sessions. The minimum detectable change (MDC) was calculated from the test-retest reliability data.


ICC values for inter-rater reliability ranged from 0.35 (95% CI: 0.05, 0.60) for fibrillar disruption to 0.77 (0.55, 0.88) for overall greyscale score, and 0.89 (0.79, 0.95) for hyperaemia. Test-retest reliability ranged from 0.70 (0.48, 0.84) for tendon thickening to 0.82 (0.66, 0.90) for overall greyscale score and 0.86 (0.73, 0.93) for calcification. The MDC for the greyscale total score was 2.0/12 and for the hyperaemia score was 1.1/5.


The sonographic scoring system used in this study may be used reliably to quantify tendon abnormalities and change over time. A relatively inexperienced imager can conduct the assessment and use the rating scales reliably.


Tennis elbow Ultrasonography Outcome assessment Reliability 


Conflicts of interest

The authors declare that there is no conflict of interest.


No financial sponsorship was involved in the production of this work.


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Copyright information

© ISS 2011

Authors and Affiliations

  • Leon Poltawski
    • 1
  • Syed Ali
    • 2
  • Vijay Jayaram
    • 3
  • Tim Watson
    • 4
  1. 1.Research FellowPeninsula College of Medicine & Dentistry ExeterEX2 4SGUK
  2. 2.Royal Preston Hospital, FulwoodPrestonUK
  3. 3.Princess Alexandra Hospital, HarlowEssexUK
  4. 4.University of HertfordshireHatfieldUK

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