Magnetic resonance imaging of patients with lateral epicondylitis: Relationship between pain and severity of imaging features in elbow joints

Yoon Ki Cha, Seon-Jeong Kim, Noh Hyuck Park, Joon Yub Kim, Joo Hak Kim, Ji Yeon Park, Yoon Ki Cha, Seon-Jeong Kim, Noh Hyuck Park, Joon Yub Kim, Joo Hak Kim, Ji Yeon Park

Abstract

Objective: The aim of this study was to determine the inter- and intra-observer reliabilities of magnetic resonance imaging (MRI) for the diagnosis of lateral epicondylitis, to examine whether degree of common extensor tendon (CET) injury is related to other elbow abnormalities on MRI, and to investigate the correlation between elbow abnormalities on MRI and patients' symptoms.

Methods: Fifty-one patients (32 women and 19 men; mean age: 50 years (range, 22-63)) with a diagnosis of lateral epicondylitis were included in the study. The average duration of symptoms was 2.3 years. MRI scoring system was used to grade the CET injuries and associated injuries in the elbow joint. Three independent radiologists retrospectively reviewed MRI images. Inter- and intra-observer reliabilities for diagnosing lateral epicondylitis were calculated using kappa statistics, and Spearman's rank correlation analysis was used to analyze relationships between degree of CET injury and the associated abnormalities of elbow joints. Statistical relations were considered significant for p values of <0.05. In addition, using Spearman's rank correlation analysis, CET injuries and associated abnormalities of elbow joints were correlated with clinical symptoms using visual analog scale pain scores.

Results: Various degrees of CET injuries were found in total of 51 patients. Radial collateral ligament and lateral ulnar collateral ligament (RCL/LCL) was the most common accompanying elbow abnormality other than CET injuries. Inter- and intra-observer agreements of CET and RCL/LUCL injuries on MRI were excellent. There were significant correlation between degrees of CET and RCL/LUCL injuries (correlation coefficient r = 0.667, p < 0.01) and between degree of RCL/LUCL injuries and visual analog 11-point pain box scale (VAS) scores (correlation coefficient r = 0.478, p = 0.033).

Conclusion: MRI showed excellent inter- and intra-observer reliabilities for the evaluation of lateral epicondylitis. In addition to common extensor tendinopathy, RCL/LUCL abnormality was the most common accompanying finding and degree of RCL/LUCL injuries positively correlated with degree of CET injuries. Furthermore, degree of RCL/LUCL injuries positively correlates with severity of pain.

Level of evidence: Level IV, Diagnostic study.

Keywords: Common extensor tendon; Lateral epicondylitis; Lateral ulnar collateral ligament; Magnetic resonance imaging; Radial collateral ligament.

Copyright © 2019 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
A 60-year old female with right elbow pain for 5 weeks. A. Coronal fat-suppressed FSE T2-weighted image showing mild thickening of the proximal portion of the common extensor tendon with increased signal intensity (arrow), suggesting mild injury. Irregular thickening with increased signal intensity in the proximal portion of the lateral collateral ligament (arrowhead) is also noted, suggesting mild injury. B and C. Coronal PD FSE image and oblique radiograph showing cortical irregularity of the lateral epicondyle (arrows), a finding suggestive of enthesophytes.
Fig. 2
Fig. 2
A 51-year-old female with left elbow pain for 1 year. Coronal fat-suppressed FSE T2-weighted image showing fluid signal intensity affecting about 50% of the thickness of the common extensor tendon (arrow), suggesting moderate injury. Irregularly thin proximal portion of the lateral collateral ligament with increased signal intensity in the proximal portion of the lateral collateral ligament (arrowhead) is also noted, suggesting moderate injury. Intramuscular edema is observed as a high signal intensity area in the extensor carpi radialis longus muscle (empty arrow).
Fig. 3
Fig. 3
A 58-year-old male with right elbow pain for 4 years. A. Coronal fat-suppressed FSE T2-weighted image showing complete tear of the proximal portion of the common extensor tendon and lateral collateral ligament (arrow), suggesting severe injury. Cortical irregularity along the lateral epicondyle (arrowheads) is shown. B. Coronal fat-suppressed FSE T2-weighted image (posterior to A) showing subcortical bone marrow edema as high signal intensity in the lateral epicondyle (arrow).

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Source: PubMed

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