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Lateral epicondylitis

Meyermann MWM - MedPix

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Affiliation: Tripler Army Medical Center

ABSTRACT

Diagnosis: Lateral epicondylitis

History: 37 y/o male with elbow pain of unknown origin.

Findings: : Recent histologic studies have shown that angiofibroblastic tendinosis with a lack of inflammation in the surgical specimens of patients with lateral epicondylitis which suggests that the abnormal signal seen on MR images is secondary to tendon degeneration and repair rather than tendinitis. MR imaging is useful in assessing the degree of tendon damage in 4-10% of the cases that are resistant to conservative therapy. Tendon degeneration is manifested by normal to increased tendon thickness with increased signal intensity in T1-weighted images that does not further increase in signal intensity on the T2-weighted images. Complete tears may be diagnosed on MR imaging by identifying a fluid filled gap separating the tendon from its adjacent bony attachment site. Magnetic resonance imaging is useful in identifying high grade partial tears and complete tears that are unlikely to improve with rest and repeated steroid injections. The lack of a significant abnormality involving the common extensor tendon on MR imaging may prompt consideration of an alternate diagnosis such as radial nerve entrapment which may mimic or accompany lateral epicondylitis. Coronal, STIR image of the elbow demonstrates high T2 signal within and surrounding the common extensor tendons consistent with lateral epicondylitis.

Ddx: Radial neuropathy, radial tunnel syndrome, lateral elbow instability, humeral fracture, radial head fracture, rotary instability of the elbow, posterior pinch syndrome/plica of the elbow, degenerative joint disease of the elbow, loose body, osteochondritis dissecans of the capitellum.

Dxhow: Radiographically and clinically.

Exam: Most of the time the patient cannot pinpoint any distinct trauma, but relates a recent increase in training or new equipment to the onset of symptoms. The athlete complains of pain over the lateral elbow, which usually is worse during the activity and slowly improves after cessation of activity. When asked to pinpoint the pain, patients often point the area just distal to the lateral epicondyle. A frequent complaint is the “coffee cup sign.” This is when the patient states that gripping their coffee cup or other object exacerbates the pain. Another frequent complaint is pain at the lateral epicondyle when shaking someone else’s hand.

No MeSH data available.


Coronal STIR images of the elbow demonstrate high T2 signal within and surrounding the common extensor tendons consistent with lateral epicondylitis.
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MPX1714_synpic20232: Coronal STIR images of the elbow demonstrate high T2 signal within and surrounding the common extensor tendons consistent with lateral epicondylitis.


Lateral epicondylitis

Meyermann MWM - MedPix

Coronal STIR images of the elbow demonstrate high T2 signal within and surrounding the common extensor tendons consistent with lateral epicondylitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1714&req=5

MPX1714_synpic20232: Coronal STIR images of the elbow demonstrate high T2 signal within and surrounding the common extensor tendons consistent with lateral epicondylitis.

View Article: MedPix Image - MedPix Case

Affiliation: Tripler Army Medical Center

ABSTRACT

Diagnosis: Lateral epicondylitis

History: 37 y/o male with elbow pain of unknown origin.

Findings: : Recent histologic studies have shown that angiofibroblastic tendinosis with a lack of inflammation in the surgical specimens of patients with lateral epicondylitis which suggests that the abnormal signal seen on MR images is secondary to tendon degeneration and repair rather than tendinitis. MR imaging is useful in assessing the degree of tendon damage in 4-10% of the cases that are resistant to conservative therapy. Tendon degeneration is manifested by normal to increased tendon thickness with increased signal intensity in T1-weighted images that does not further increase in signal intensity on the T2-weighted images. Complete tears may be diagnosed on MR imaging by identifying a fluid filled gap separating the tendon from its adjacent bony attachment site. Magnetic resonance imaging is useful in identifying high grade partial tears and complete tears that are unlikely to improve with rest and repeated steroid injections. The lack of a significant abnormality involving the common extensor tendon on MR imaging may prompt consideration of an alternate diagnosis such as radial nerve entrapment which may mimic or accompany lateral epicondylitis. Coronal, STIR image of the elbow demonstrates high T2 signal within and surrounding the common extensor tendons consistent with lateral epicondylitis.

Ddx: Radial neuropathy, radial tunnel syndrome, lateral elbow instability, humeral fracture, radial head fracture, rotary instability of the elbow, posterior pinch syndrome/plica of the elbow, degenerative joint disease of the elbow, loose body, osteochondritis dissecans of the capitellum.

Dxhow: Radiographically and clinically.

Exam: Most of the time the patient cannot pinpoint any distinct trauma, but relates a recent increase in training or new equipment to the onset of symptoms. The athlete complains of pain over the lateral elbow, which usually is worse during the activity and slowly improves after cessation of activity. When asked to pinpoint the pain, patients often point the area just distal to the lateral epicondyle. A frequent complaint is the “coffee cup sign.” This is when the patient states that gripping their coffee cup or other object exacerbates the pain. Another frequent complaint is pain at the lateral epicondyle when shaking someone else’s hand.

No MeSH data available.