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Age / Sex : 62 / F
Age / Sex : 40 years old / Male
Chief complaint : Pain on resisted wrist extension at the lateral elbow joint for 2 years
1) What is your impression?
* Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD ([email protected])
Courtesy: Doo Hoe Ha, MD., Bundang CHA General Hospital
Diagnosis: lateral epicondylitis
Discussion
Findings:
Elbow AP view is not remarkable.
US : The common extensor tendon, especially anterior portion, shows diffuse hypoechoic swelling with increased vascularity. Small bony spur on the lateral epicondylar margin is seen.
Diagnosis: Tennis elbow ( Tendinosis of the common extensor tendon )
Discussion:
Lateral epicondylitis is caused by repetitive traction on the osteotendinous attachment of the common extensor tendon. This can be result of chronic microtrauma resulting in degeneration and / or partial tear of the common extensor tendon, or to damage to the bone insertion (enthesopathy). Extensor carpi radialis brevis tendon is the most commonly affected. In one-third of patients, the origin of the extensor digitorum communis tendon is involved as well.
The ultrasound features are hypoechoic swelling of the common extensor tendon, loss of fibrillary pattern of tendon, ill-defined tendon margins. In high grade tendinosis, hypervascular pattern in the tendon substance due to angiofibroblastic infiltration can be seen. Bony spur at the tendon insertion site with cortical irregularity may be recongnized. In partial tears focal hypoechoic change or thinning of the tendon is noted. In complete tears, fluid-filled gap separates the tendon from its bony attachment site.
References:
Biachi S, Martinoli C. Elbow. In Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system. Berlin : Springer, 2007; 378 - 381
Van Holsbeeck MT, Introcase JH. Musculoskeletal ultrasound. St. Louis : Mosby 2001 : 224 - 227
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