Fact-sheet: Lateral epicondylitis - Tennis elbow


Updated on 09/01/2022 at 4:06 PM

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Definition

Tendinopathy of the common extensor tendon origin at the lateral epicondyle (extensor carpi radialis brevis, extensor digitorum communis, superficial head of the supinator muscle, extensor digiti minimi, extensor carpi ulnaris).

Occurs after repetitive microtrauma during occupational or sports activities ("tennis elbow").

Clinical features

  • Pain localized to the lateral aspect of the elbow (lateral epicondyle).
  • Pain elicited by resisted wrist extension.
  • Tenderness on palpation of the origin of the common extensor tendon.

Radiography

Useful for differential diagnosis (osteoarthritis, trauma)

+/- calcifications overlying the common extensor tendon insertion, indicating hydroxyapatite deposition disease.

Ultrasound

  • Hypoechoic intratendinous area with loss of the normal fibrillar pattern of the tendon.
  • Increased tendon caliber.
  • Power Doppler: intratendinous or peritendinous hyperemia.
  • More or less linear anechoic intratendinous lesion, consistent with a partial or complete tear.
  • Focal concavity in cases of partial tear.
  • Peritendinous effusion.
  • Intratendinous calcification/ossification in cases of chronic involvement.
  • Irregularity of the epicondylar cortex.
  • Medial collateral ligament injury

MRI

Common extensor tendon origin: thickened and of increased signal (T2 hyperintense).

Partial tendon tears seen as fluid-like T2 hyperintensity.