【PHILIPS DAILY EXAMPLE】 "TENNIS ELBOW" EXAMPLE

Recently, a case of tennis elbow provided by Michael Hsu et al.
was published on the website of AuntMinnie Imaging, which has great clinical guiding significance
.

Basic history: male, 59 years old, right elbow pain, MRI scan of right elbow as follows
.

MRI features: thickening at the beginning of the common extensor tendon and increased internal signal, similar
to the signal change in moderate lateral epicondylitis.
The lateral collateral ligament is intact
.

Differential diagnosis: mild lateral epicondylitis of the humerus; moderate lateral epicondylitis of the humerus; Severe lateral epicondylitis of the humerus

Diagnosis: moderate lateral epicondylitis of the humerus

Anatomy: Extensor carpicanus radialis (ECRB), which refers to the joint tendon of the total extensor muscle and ulnar extensor muscle, together with the extensor digitus pinky and supinator muscles to form the extensor common tendon, which is fixed in front of
the lateral epicondyle and lateral supracondylar crest.
ECRB is distributed in the deepest and anterior part of the extensor common tendon, and its underside slides
along the lateral edge of the humerus head during elbow flexion.

Lateral epicondylitis generally involves the ECRB, followed by the extensor common tendon.

The start is adjacent to the brachioradialis and extensor carpi longus
radial.
The lateral collateral ligament conformant body consists of
a radial collateral ligament, a annular ligament, an adnexal lateral collateral ligament, and a lateral ulnar collateral ligament distributed deep in the ECRB.

Clinical features:

"Tennis elbow" is generally caused
by repeated backhand and forearm pronation during elbow extension, especially excessive varus pressure at the ECRB area.
Immature repair reactions lead to small tears and progressive degeneration, which eventually leads to tendon degeneration (not tendonitis, due to the lack of inflammatory components
.
In addition, ECRB is opposite the lateral part of the humeral head, and its surface is susceptible to injury; The surface of the tendon lacks vascular distribution, which accelerates the process of
its degeneration.

"Tennis elbow" is the most common cause of pain in the lateral part of
the elbow joint.

"Tennis elbow" is more common between the ages of 40 and 50 years and affects men and women equally
.

Lateral elbow pain with tenderness at the beginning of ECRB (1 cm from the midpoint of the lateral epicondyle)

In more severe cases, it is generally associated with
tears of the lateral and radial collateral ligaments of the ulnar collateral ligament.

Image features

MRI findings The extensor common tendon and lateral ligament are generally uniformly low-intensities
across all sequences.

Tendon degeneration: tendons (more commonly in ECRB) with or without thickening with moderate T1
/T2 signal.

Partial or full-thickness tears present as partial or full-thickness fluid signals in the superior tendon, with diffuse tendon thinning
.

Different gradings:

Mild—tendon degeneration or low-grade partial tears (low-grade tears typically involve less than 20% of tendon thickness)

Moderate—intermediate partial tear (involving 20% to 80% of tendon thickness)

Severe—high-grade partial or full-thickness tears (involving >80% of tendon thickness)

Tears associated with the lateral part of the ulnar collateral ligament can cause instability
in lateral rotation.

Ultrasound findings:

Ultrasound generally uses elbow flexion and forearm pronation, transverse and longitudinal scanning
.

The ECRB is the anterior fibrous tissue
of the extensor common tendon.

Tendon degeneration—Tendon thickening with bleeding and heterogeneity
.

Tear — Hypoechoic or non-echoic on ultrasound
due to lack of normal fibrous structure and rupture of adjacent tendons.

There may be edema and calcification
around.

The grade is the same
as on MRI.

treat

Conservative management—rest/ice, NSAIDs, steroid injections, or splint/pull-in plus rehabilitation
.

Other therapies—autologous blood or platelet-rich plasma, ultrasound-guided tenotomy, extracorporeal pulse therapy, and iontophoresis/ultrasound drug dialysis
.

Surgery—If conservative treatment is ineffective for 6~8 months, surgery (release and debridement of degenerative tendons)
is used.