Lateral Epicondylitis

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Lateral epicondylitis is a pathologic condition of the common extensor tendon at its origin from the lateral epicondyle. Lateral epicondylitis also is known as tennis elbow because more than 50% of tennis players develop the condition at some time or another [36]. Lateral epicondylitis is far more common in

Fig. 13. Normal ulnar band of the lateral collateral ligament. Coronal fat-suppressed T2-weighted fast spin-echo image of the elbow shows the normal low signal intensity ulnar band of the lateral collateral ligament (arrowheads) extending from the lateral epicondyle to the lateral aspect of the proximal ulna.

Fig. 13. Normal ulnar band of the lateral collateral ligament. Coronal fat-suppressed T2-weighted fast spin-echo image of the elbow shows the normal low signal intensity ulnar band of the lateral collateral ligament (arrowheads) extending from the lateral epicondyle to the lateral aspect of the proximal ulna.

Fig. 14. Full-thickness tear of the ulnar band of the lateral collateral ligament in a 40-year-old male with lateral elbow pain following trauma. Coronal fat-suppressed T2-weighted fast spinecho image of the elbow shows complete absence of the proximal fibers of the ulnar band of the lateral collateral ligament that normally attach to the lateral epicondyle (arrowhead). Note the associated posttraumatic bone marrow edema within the distal humerus, proximal ulna, and radial head (arrows).

nonathletes, however. Lateral epicondylitis is believed to represent an incomplete healing response to an initial microscopic or macroscopic avulsion injury of the common extensor tendon. The pathologic condition usually involves the origin of the extensor carpi radialis brevis tendon from the lateral epicondyle of the humerus. The origins of the extensor digitorum communis and extensor carpi radialis longus tendon occasionally are involved also [36-40].

MRI may be useful in evaluating the common extensor tendon origin in patients with lateral epicondylitis. MRI rarely is needed, however, because most patients are diagnosed easily by clinical history and physical examination. In individuals who do not respond to conservative treatment MRI may be helpful to determine the extent of tissue damage to the common extensor tendon origin and to exclude other causes of lateral elbow pain [41].

The common extensor tendon origin in patients with lateral epicondylitis usually is thickened and shows increased signal intensity on T1-weighted and T2-weighted images (Fig. 15). The areas of increased signal intensity within the diseased tendon correspond to areas of mucoid degeneration and neovascularization on histopathologic analysis. In many individuals with lateral epicondylitis, the common extensor tendon origin is thinned and shows areas of intense fluid-like signal intensity on T2-weighted images (Fig. 16). These areas of high T2 signal intensity usually correspond to areas of significant disruption of collagen fibers. Occasionally, however, they may represent areas of mucoid degeneration and neovascularization without disruption of the normal parallel orientation of collagen fibers [41,42]. Additional MRI findings in patients with lateral epicondylitis include bone marrow edema and periostitis of the lateral epicondyle, anconeus muscle edema, and fluid within the radial head bursa [43-46].

Lateral Epicondylitis Mri
Fig. 15. Lateral epicondylitis in a 57-year-old male with chronic lateral elbow pain. Coronal T2-weighted fast spin-echo image of the elbow shows thickening and abnormal intermediate signal intensity within the common extensor tendon origin (arrowhead).

The normal common extensor tendon origin usually shows homogenous low signal intensity on Tl-weighted and T2-weighted MRI images. Focal areas of increased T1 signal intensity within the origin of the common extensor tendon may be seen in asymptomatic individuals, however. In addition, increased T1 and T2 signal intensity within a thickened common extensor tendon origin has been described in asymptomatic high-performance athletes [42]. Furthermore, increased T2 signal intensity may be seen within and around the common extensor tendon for as long as one month following the injection of corticosteroid for treatment of lateral epicondylitis [47].

The MRI images of individuals with suspected lateral epicondylitis should be evaluated carefully for associated injuries to the lateral collateral ligament. One

Mri Lateral Epicondylitis

Fig. 16. Lateral epicondylitis in a 53-year-old female with chronic lateral elbow pain. Axial fat-suppressed T2-weighted fast spin-echo image (A) and coronal fat-suppressed T2-weighted fast spin-echo image (B) of the elbow shows thinning and abnormal fluid-like signal intensity within the common extensor tendon origin (white arrowheads).

Fig. 16. Lateral epicondylitis in a 53-year-old female with chronic lateral elbow pain. Axial fat-suppressed T2-weighted fast spin-echo image (A) and coronal fat-suppressed T2-weighted fast spin-echo image (B) of the elbow shows thinning and abnormal fluid-like signal intensity within the common extensor tendon origin (white arrowheads).

study evaluated the ulnar band of the lateral collateral ligament in 35 consecutive patients who were referred for MR imaging of the elbow to rule out lateral epicondylitis. The vast majority of individuals with moderate to severe lateral epicondylitis were found to have associated partial-thickness and full-thickness tears of the ulnar band of the lateral collateral ligament [48]. If the lateral collateral ligament tears and the associated posterolateral rotatory instability of the elbow are not recognized, these individuals may be surgically treated for lateral epicondylitis with debridement of the common extensor tendon origin. This surgical procedure may destabilize the elbow further and worsen symptoms in these patients [49].

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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