The ultrasound elastography findings in lateral epicondylitis in comparison with healthy individuals

Yıl 2022, Cilt: 16 Sayı: 1, 33 - 40, 20.04.2022

Bilge İpek Torun Serhan Eren Mehtap Balaban

Öz

Objectives: To evaluate the ability of strain sonoelastography (SEL) in diagnosing lateral epicondylitis (LE) and to asses clinical and diagnostic efficacy of strain SEL in patients with clinically confirmed LE and in healthy volunteers.
Methods: Strain SEL was performed on 110 patients with clinical symptoms of LE and on 56 healthy participants. The common extensor tendon (CET) was evaluated with gray-scale and color Doppler ultrasonography (CDUS). The stiffness and the elasticity of the CET was divided into 2 main types and 2 subtypes as a spectrum ranging from hard for 1a to soft for 2b.
Results: The thickness of the CET in patients with LE (6.3±1.06 mm) were remarkably thicker than in healthy participants (3.8±0.62 mm) (p<0.001). There were negative significant correlations between the thickness of the CET and lower and mean strain ratios (SR) (rs= [–0.666], p<0.001 for lower SR and rs= [–0.358], p<0.001 for mean SR). Thickness of the CET varied between the groups of elastographic patterns (p<0.001). The SR of tendon in patients with LE (6.68±2.49 mm) were remarkably lower than in healthy participants (11.16±4.88 mm) (p<0.001). The SR of tendon in patients with LE also varied significantly between the groups of elastographic patterns (p<0.001).
Conclusion: Strain SEL is a promising sonographic technique for musculoskeletal imaging to differentiate thickening and softening of CET in LE. SR and SEL pattern findings are compatible with gray scale ultrasound and CDUS findings.

Anahtar Kelimeler

common extensor tendon, imaging, radiologic anatomy, tendon thickness

Kaynakça

• Aslan H, Kimelman-Bleich N, Pelled G, Gazit D. Molecular targets for tendon neoformation. J Clin Invest 2008;118:439–44.
• Jaén-Díaz JI, Cerezo-López E, López-de Castro F, Mata-Castrillo M, Barceló-Galíndez JP, De la Fuente J, Balius-Mata Ramón. Sonographic findings for the common extensor tendon of the elbow in the general population. J Ultrasound Med 2010;29:1717–24.
• Whaley AL, Baker CL. Lateral epicondylitis. Clin Sports Med 2004;23:677–91.
• Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician 2007;76:843–8.
• Levin D, Nazarian LN, Miller TT, O'Kane PL, Feld RI, Parker LP, McShane JM. Lateral epicondylitis of the elbow: US findings. Radiology 2005;237:230–4.
• Potter HG, Hannafin JA, Morwessel RM, DiCarlo EF, O’Brien SJ, Altchek DW. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology 1995;196:43–6.
• Sigrist RM, Liau J, El Kaffas A, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics 2017;7:1303–1329.
• Chang JM, Moon WK, Cho N, Yi A, Koo HR, Han W, Noh D-Y, Moon H-G, Kim SJ. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat 2011;129:89–97.
• Balaban M, Cilengir AH, Idilman IS. Evaluation of tendon disorders with ultrasonography and elastography. J Ultrasound Med 2021;40:1267–86.
• Dilip D, Khaladkar SM, Chanabasanavar V, Parripati SSVK. Real-time strain elastography: applications in musculoskeletal system. J Clin Orthop Trauma 2022;26:101784.
• Liu Q, Tang L, Chen M. Ultrasound strain elastography and contrast-enhanced ultrasound in predicting the efficacy of neoadjuvant chemotherapy for breast cancer: a nomogram integrating Ki-67 and ultrasound features. J Ultrasound Med 2022;41:2191–201.
• Mutala TM, Mwango GN, Aywak A, Cioni D. Determining the elastography strain ratio cut off value for differentiating benign from malignant breast lesions: systematic review and meta-analysis. Cancer Imaging 2022;22:12.
• Wadugodapitiya S, Sakamoto M, Tanaka M,Sakagami Y, Morise Y, Kobatashi K. Assessment of knee collateral ligament stiffness by strain ultrasound elastography. Biomed Mater Eng 2022;33:337–49.
• Wang Y, Jacobson DS, Urban MW. A non-invasive method to estimate the stress-strain curve of soft tissue using ultrasound elastography. Ultrasound Med Biol 2022;48:786–807.
• Steinmann S, Pfeifer CG, Brochhausen C, Docheva D. Spectrum of tendon pathologies: triggers, trails and end-state. Int J Mol Sci 2020;21:844.
• Cha YK, Kim S-J, Park NH, Kim JY, Kim JH, Park JY. Magnetic resonance imaging of patients with lateral epicondylitis: relationship between pain and severity of imaging features in elbow joints. Acta Orthop Traumatol Turc 2019;53:366–71.
• Droppelmann G, Feijoo F, Greene C, Tello M, Rosales J, Yanez R, Jorquera C, Prieto D. Ultrasound findings in lateral elbow tendinopathy: a retrospective analysis of radiological tendon features. F1000Research 2022;11:44.
• Krogh TP, Fredberg U, Ammitzbøll C, Ellingsen T. Clinical value of ultrasonographic assessment in lateral epicondylitis versus asymptomatic healthy controls. Am J Sports Med 2020;48:1873–83.
• Connell D, Burke F, Coombes P, McNealy S, Freeman D, Pryde D, Hoy G. Sonographic examination of lateral epicondylitis. AJR Am J Roentgenol 2001;176:777–82.
• Speers CJ, Bhogal GS, Collins R. Lateral elbow tendinosis: a review of diagnosis and management in general practice. Br J Gen Pract 2018;68:548–9.
• Ahn K-S, Kang CH, Hong S-J, Jeong W-K. Ultrasound elastography of lateral epicondylosis: clinical feasibility of quantitative elastographic measurements. AJR Am J Roentgenol 2014;202:1094–9.
• Zhu B, You Y, Xiang X, Wang L, Qui L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg 2020;10:211–9.
• Khoury V, Cardinal E. “Tenomalacia”: a new sonographic sign of tendinopathy? Eur Radiol 2009;19:144–6.
• De Zordo T, Lill SR, Fink C, Feuchtner GM, Jaschke W, Bellmann-Weiler R, Klauser AS. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol 2009;193:180–5.
• Ohrndorf S, Naumann L, Grundey J, Scheel T, Scheel AK, Werner C, Backhaus M. Is musculoskeletal ultrasonography an operator-dependent method or a fast and reliably teachable diagnostic tool? Interreader agreements of three ultrasonographers with different training levels. Int J Rheumatol 2010;2010:164518.
• Sowa Y, Numajiri T, Itsukage S, Nishino K. Comparison of shear-wave and strain ultrasound elastography for evaluating fat induration after breast reconstruction. Plast Reconstr Surg Glob Open 2016;4:e677.