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Diagnostic ultrasound imaging for lateral epicondylalgia: A case-control study

journal contribution
posted on 21.08.2018, 00:00 by Luke HealesLuke Heales, N Broadhurst, R Mellor, PW Hodges, B Vicenzino
Copyright © 2014 by the American College of Sports Medicine.Introduction: Lateral epicondylalgia (LE) is clinically diagnosed as pain over the lateral elbow that is provoked by gripping. Usually, LE responds well to conservative intervention; however, those who fail such treatment require further evaluation, including musculoskeletal ultrasound. Previous studies of musculoskeletal ultrasound have methodological flaws, such as lack of assessor blinding and failure to control for participant age, sex, and arm dominance. The purpose of this study was to assess the diagnostic use of blinded ultrasound imaging in people with clinically diagnosed LE compared with that in a control group matched for age, sex, and arm dominance.Methods: Participants (30 with LE and 30 controls) underwent clinical examination as the criterion standard test. Unilateral LE was defined as pain over the lateral epicondyle, which was provoked by palpation, resisted wrist and finger extension, and gripping. Controls without symptoms were matched for age, sex, and arm dominance. Ultrasound investigations were performed by two sonographers using a standardized protocol. Grayscale images were assessed for signs of tendon pathology and rated on a four-point ordinal scale. Power Doppler was used to assess neovascularity and rated on a five-point ordinal scale.Results: The combination of grayscale and power Doppler imaging revealed an overall sensitivity of 90% and specificity of 47%. The positive and negative likelihood ratios for combined grayscale and power Doppler imaging were 1.69 and 0.21, respectively.Conclusions: Although ultrasound imaging helps confirm the absence of LE, when findings are negative for tendinopathic changes, the high prevalence of tendinopathic changes in pain-free controls challenges the specificity of the measure. The validity of ultrasound imaging to confirm tendon pathology in clinically diagnosed LE requires further study with strong methodology.

History

Volume

46

Issue

11

Start Page

2070

End Page

2076

Number of Pages

7

eISSN

1530-0315

ISSN

0195-9131

Publisher

Lippincott Williams & Wilkins

Peer Reviewed

Yes

Open Access

No

Era Eligible

Yes

Journal

Medicine and Science in Sports and Exercise