European Radiology

, Volume 28, Issue 1, pp 390–397 | Cite as

Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis

  • Sang Ho Yoo
  • Jang Gyu Cha
  • Bo Ra Lee



To determine the clinical efficacy of sonographically-guided percutaneous bone drilling of the lateral epicondyle (LE) for the treatment of patients with LE.


We included 24 patients with LE who reported pain in this study. All patients underwent sonographically-guided percutaneous bone drilling of the lateral epicondyle. Follow-up sonography and physical examinations were performed 1, 3 and 6 months after the procedure. The outcome measures included sonographic findings, visual analogue scale (VAS) score, maximum voluntary grip strength (MVGS) and patient-related tennis elbow evaluation (PRTEE) score.


None of the patients had immediate complications during the procedure. The area of the extensor carpi radialis brevis (ECRB) tears decreased significantly at 1 month and declined gradually over the remaining 5 months of the study (p < 0.001). The mean pain VAS score was significantly lower at 6 months than preoperatively (respectively; p < 0.001). The mean MVGS increased significantly between pretreatment and 6 months post-treatment (p < 0.001), whereas the PRTEE score decreased significantly during the same period (p < 0.001).


Sonographically-guided percutaneous drilling is a quick and safe treatment option for LE that can be performed in an outpatient setting.

Key Points

Percutaneous drilling of the lateral condyle is effective for the treatment of LE.

The area of ECRB tears can be measured by US-guided saline injection.

US-guided percutaneous drilling is a quick and safe treatment option for LE.


Ultrasonography Tennis elbow Sports medicine Elbow joint Treatment outcome 


Compliance with ethical standards


The scientific guarantor of this publication is Jang Gyu Cha.

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.


This study has received funding by Soonchunghayng University Research Fund.

Statistics and biometry

Bo Ra Lee kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• case-series study

Supplementary material

330_2017_4932_MOESM1_ESM.mp4 (455 kb)
Video 1 US-guided saline injection into the ECRB tear site. When the injected fluid had fully collected in the hypoechoic clefts, the tendon tear in the ECRB was clearly demarcated on sonography as a hyperechoic ovoid lesion. (MP4 455 kb)
330_2017_4932_MOESM2_ESM.mp4 (510 kb)
Video 2 US-guided drilling procedure. The wire was then advanced through the diseased tendon site until the bony cortex was punctured just below the tear site. (MP4 509 kb)
330_2017_4932_MOESM3_ESM.mp4 (298 kb)
Video 3-4 Preoperative (Video 3) and follow-up sonographic images (video 4) A 34-year-old man clinically diagnosed with lateral epicondylitis. After the injection of saline into the ECRB tendon tear, preoperative evaluation using grey-scale ultrasonography (US) showed an inflated tear as a low-echoic cyst in the extensor origin (arrows) (Video 3). The area of the tear was 0.14 cm2. Ultrasound of the extensor origin 6 months postoperatively revealed a decrease in the area of the tear (Video 4). (MP4 297 kb)
330_2017_4932_MOESM4_ESM.mp4 (398 kb)
(MP4 398 kb)


  1. 1.
    Sayegh ET, Strauch RJ (2015) Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin Orthop Relat Res 473:1093–1107CrossRefPubMedGoogle Scholar
  2. 2.
    Smidt N, van der Windt DA (2006) Tennis elbow in primary care. BMJ 333:927–928CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lee MH, Cha JG, Jin W et al (2011) Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. AJR Am J Roentgenol 196:1363–1367CrossRefPubMedGoogle Scholar
  4. 4.
    Ahmad Z, Siddiqui N, Malik SS, Abdus-Samee M, Tytherleigh-Strong G, Rushton N (2013) Lateral epicondylitis: a review of pathology and management. Bone Joint J 95-b:1158–1164CrossRefPubMedGoogle Scholar
  5. 5.
    du Toit C, Stieler M, Saunders R, Bisset L, Vicenzino B (2008) Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow. Br J Sports Med 42:572–576CrossRefGoogle Scholar
  6. 6.
    Clarke AW, Ahmad M, Curtis M, Connell DA (2010) Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. Am J Sports Med 38:1209–1214CrossRefPubMedGoogle Scholar
  7. 7.
    Orchard J, Kountouris A (2011) The management of tennis elbow. BMJ 342:d2687CrossRefPubMedGoogle Scholar
  8. 8.
    Walz DM, Newman JS, Konin GP, Ross G (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30:167–184CrossRefPubMedGoogle Scholar
  9. 9.
    Hechtman KS, Uribe JW, Botto-vanDemden A, Kiebzak GM (2011) Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Orthopedics 34:92PubMedGoogle Scholar
  10. 10.
    Mishra A, Pavelko T (2006) Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 34:1774–1778CrossRefPubMedGoogle Scholar
  11. 11.
    Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M (2006) Ultrasound-guided autologous blood injection for tennis elbow. Skelet Radiol 35:371–377CrossRefGoogle Scholar
  12. 12.
    Edwards SG, Calandruccio JH (2003) Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am] 28:272–278CrossRefGoogle Scholar
  13. 13.
    Keizer SB, Rutten HP, Pilot P, Morre HH, v Os JJ, Verburg AD (2002) Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Relat Res: 125–131Google Scholar
  14. 14.
    Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM (2011) Clinical and ultrasonographic results of ultrasonographically-guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis. Am J Sports Med 39:2429–2435CrossRefPubMedGoogle Scholar
  15. 15.
    Coleman B, Quinlan JF, Matheson JA (2010) Surgical treatment for lateral epicondylitis: a long-term follow-up of results. J Shoulder Elb Surg 19:363–367CrossRefGoogle Scholar
  16. 16.
    Garden RS (1961) Tennis elbow. J Bone Joint Surg Br Vol 43-B:100–106Google Scholar
  17. 17.
    Barnes DE, Beckley JM, Smith J (2015) Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elb Surg 24:67–73CrossRefGoogle Scholar
  18. 18.
    Chiavaras MM, Jacobson JA (2013) Ultrasound-guided tendon fenestration. Semin Musculoskelet Radiol 17:85–90CrossRefPubMedGoogle Scholar
  19. 19.
    Housner JA, Jacobson JA, Misko R (2009) Sonographically-guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 28:1187–1192CrossRefPubMedGoogle Scholar
  20. 20.
    Rompe JD, Overend TJ, MacDermid JC (2007) Validation of the patient-rated tennis elbow evaluation questionnaire. J Hand Ther 20:3–10, quiz 11 CrossRefPubMedGoogle Scholar
  21. 21.
    Dunn JH, Kim JJ, Davis L, Nirschl RP (2008) Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med 36:261–266CrossRefPubMedGoogle Scholar
  22. 22.
    Hayashi K, Kumai T, Higashiyama I, Shinohara Y, Matsuda T, Takakura Y (2009) Repair process after fibrocartilaginous enthesis drilling: histological study in a rabbit model. J Orthop Sci 14:76–84CrossRefPubMedGoogle Scholar
  23. 23.
    Schipper ON, Dunn JH, Ochiai DH, Donovan JS, Nirschl RP (2011) Nirschl surgical technique for concomitant lateral and medial elbow tendinosis: a retrospective review of 53 elbows with a mean follow-up of 11.7 years. Am J Sports Med 39:972–976CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of OrthopaedicsYoo-Sang-Ho Orthopaedic ClinicSeoulKorea
  2. 2.Department of RadiologySoonchunhyang University Bucheon HospitalBucheon-siKorea

Personalised recommendations