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



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.

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Author information



Corresponding author

Correspondence to Jang Gyu Cha.

Ethics declarations


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

Electronic supplementary material

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)

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)

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)

(MP4 398 kb)

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Yoo, S.H., Cha, J.G. & Lee, B.R. Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis. Eur Radiol 28, 390–397 (2018). https://doi.org/10.1007/s00330-017-4932-7

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  • Ultrasonography
  • Tennis elbow
  • Sports medicine
  • Elbow joint
  • Treatment outcome