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

  • Musculoskeletal
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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.


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.


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.


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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Area under the curve


Common extensor tendon


Extensor carpi radialis brevis


Full thickness tear


Intraclass correlation coefficient


Lateral collateral ligament


Magnetic resonance


Partial thickness tear


Range of motion


Visual analogue scale


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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.


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

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Correspondence to Min Hee Lee.

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

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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.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• 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).

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