Abstract
Purpose
The aim is to examine the common extensor tendon (CET) thicknesses at three locations in the normal population with ultrasound (US), to determine changes related to dominancy, age, gender, body mass index and to evaluate structural changes in normal tendons.
Methods
The study included 100 normal volunteers (200 elbows). CET was examined at three landmark locations bilaterally (humeral, articular and radial) and if present, other structural abnormalities such as tendinosis (focal or diffuse tendon echogenicity changes), tears, bone changes (enthesophytes, spurs, irregularities), tendon calcification, effusion and neovascularization were noted.
Results
Common extensor tendon was thicker on the dominant side at all three locations (humeral 4.60 versus 4.22 mm, articular 3.55 versus 3.23 mm, radial 3.17 versus 2.88 mm, p < 0.001) and gradually tapered from proximal to distal, moderate relation with age and BMI was present, most pronounced at the humeral location. Bone changes (spurs, irregularities) correlated positively with age and CET thickened in the dominant arm after 42.5 years of age which was also a cut-off age for bone changes (p < 0.05). Asymptomatic tendinosis (12 %) within the normal population was significantly related to the dominancy (p = 0.032) but was not influenced by age, gender, BMI, bone degeneration or tendon thickening.
Conclusion
When interpreting CET thickness, caution should be placed on tendon measurement points in addition to variables such as age, gender, BMI, dominancy and bone changes. Structural tendon changes (tendinosis) may be encountered in the symptom free (healthy), normal population and, not tendon thickening but dominancy is a feature of this asymptomatic tendinosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Beggs I, Bianchi S, Bueno A et al (2007) Musculoskeletal ultrasound technical guidelines: II. Elbow. Eur Soc Musculoskelet Radiol. http://www.essr.org/html/img/pool/elbow.pdf. Accessed in 02 Feb 2011
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 38:1209–1214
Croisier JL, Foidart-Desalle M, Tinant F, Crielaard JM, Forthomme B (2007) An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med 41:269–275
du Toit C, Stieler M, Saunders R, Bisset L, Vicenzino B et al (2008) Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow. Br J Sports Med 42:872–876
Hannouche D, Be′gue′ T (1999) Functional anatomy of the lateral collateral ligament complex of the elbow. Surg Radiol Anat 21:187–191
Jaén-Díaz JI, Cerezo-López E, López-de Castro F, Mata-Castrillo M, Barceló- Galindez JP, De la Fuente J, Bailus-Mata R et al (2010) Sonographic findings for the common extensor tendon of the elbow in the general population. J Ultrasound Med 29:1717–1724
Lee MH, Cha JG, Jin W, Kim BS, Park JS, Lee HK, Hong HS (2011) Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. AJR Am J Roentgenol 196:1363–1367
Levin D, Nazarian LN, Miller TT, O’Kane PL, Feld RI, Parker L, McShane JM (2005) Lateral epicondylitis of the elbow: US findings. Radiology 237:230–234
Maffuli N, Regine R, Carrillo F, Capasso G, Minelli S (1990) Tennis elbow: an ultrasonographic study in tennis players. Br J Sports Med 24:151–155
Miller TT, Shapiro MA, Schultz E, Kalish PE (2002) Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound 30:193–202
Molinier F, Laffose JM, Bouali O, Tricoire JL, Moscovici J (2011) The anconeous, an active ligament of the elbow: new anatomical arguments. Surg Radiol Anat 33:617–621
Nayak SR, Ramanathan L, Krishnamurthy A, Prabhu LV, Madhyastha S, Potu BK, Ranade AV (2010) Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis. Surg Radiol Anat 32:207–211
Noh KH, Moon YL, Jacir AM, Kim KH, Gorthi V (2010) Sonographic probe induced tenderness for lateral epicondylitis: an accurate technique to confirm the location of the lesion. Knee Surg Sports Traumatol Arthrosc 18:836–839
Regan W, Wold LE, Coonrad R, Morrey BF (1992) Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 20:746–749
Stewart B, Harish S, Oomen G, Wainman B, Popowich T, Moro JK (2009) Sonography of the lateral ulnar collateral ligament of the elbow: study of cadavers and healthy volunteers. AJR Am J Roentgenol 193:1615–1619
Struijs PA, Spruyt M, Assendelft WJ, van Dijk CN (2005) The predictive value of diagnostic sonography for the effectiveness of conservative treatment of tennis elbow. AJR Am J Roentgenol 185:1113–1118
Walz DM, Newman JS, Konin GP, Ross G (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30:167–184
Zeisig E, Fahlström M, Ohberg L, Alfredson H (2008) Pain relief after intratendinous injections in patients with tennis elbow: results of a randomized study. Br J Sports Med 42:267–271
Zeisig E, Fahlström M, Ohberg L, Alfredson H (2010) A two-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow. Br J Sports Med 44:584–587
Conflict of interest
The authors declare no conflict of interests.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ustuner, E., Toprak, U., Baskan, B. et al. Sonographic examination of the common extensor tendon of the forearm at three different locations in the normal asymptomatic population. Surg Radiol Anat 35, 547–552 (2013). https://doi.org/10.1007/s00276-013-1084-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-013-1084-6