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Lateral Elbow Tendinosis/Lateral Epicondylitis or tennis elbow

The lateral elbow tendinosis or "tennis elbow", is the most common source of elbow pain in the general population and may be produced by a variety of overuse activities.
On MRI the normal common extensor tendons are seen as smooth well defined black structures of uniform thickness on all sequences. Tendinosis manifest by thickening and signal change. In the early stages, the tendon demonstrates poorly defined low to intermediate signal change on T1weighted images, with a relative increase in signal on T2 weighted images. On T2 weighted sequences with fat suppression or STIR imaging, the affected tendon returns high signal. In later stages, cystic change may occur, with focal areas of high signal seen within the tendon on T2 weighted images. This may be complicated by partial or complete tears of the tendon and be associated with collateral ligament derangement.

See similar "Tennis Elbow" case

Cor T2 Fat Sat demonstrates bright signal in the origin of the common extensor tendon which involves lateral collateral ligament
Cor T2 Fat Sat demonstrates bright signal in the origin of the common extensor tendon which involves lateral collateral ligament

Cor T1 GRE
Cor T1 GRE

Ax PD Fat Sat
Ax PD Fat Sat

42 yo with elbow pain

The first description of lateral epicondylitis generally is attributed to Runge in 1873. Since this initial report, much controversy over the pathophysiology and treatment of this disorder has existed. The lateral epicondyle, which serves as the site of attachment for the extensor-supinator muscle group as well as the radial collateral ligament, is not implicated in the pathology and term "epicondylitis" is not suitable.

The primary abnormality of "tennis elbow" involves the origin of the extensor carpi radialis brevis and less commonly the anterior aspect of the extensor digitorum tendon. The extensor carpi radialis brevis is the most lateral muscle contracts at a higher level during daily functional tasks and contracts more powerfully during the backhand stroke of tennis. It has a complex origin, receiving contribution from the common extensor tendon, the lateral collateral ligament, the annular ligament, the overlying fascia, and intramuscular septum. These contributions are intertwined and are not always separable on either MRI, sonography or at surgery. The lateral collateral ligament lies immediately deep in relation to the common extensor origin. It is more likely to be thickened, partially torn, or completely torn with more severe grades of lateral elbow tendinosis.

The wrist extensor-supinator group falls into the category of tendons particularly vulnerable to injury. The lateral elbow tendinosis or "tennis elbow", is the most common source of elbow pain in the general population and may be produced by a variety of overuse activities. The tendons have poor vascular supply, wrap around a convex surface and are subjected to repetitive stress.

On MRI the normal common extensor tendons are seen as smooth well defined black structures of uniform thickness on all sequences. Tendinosis manifest by thickening and signal change. In the early stages, the tendon demonstrates poorly defined low to intermediate signal change on T1weighted images, with a relative increase in signal on T2 weighted images. On T2 weighted sequences with fat suppression or STIR imaging, the affected tendon returns high signal. In later stages, cystic change may occur, with focal areas of high signal seen within the tendon on T2 weighted images. This may be complicated by partial or complete tears of the tendon and be associated with collateral ligament derangement.

This case demonstrates tendinosis of origin of the common extensor tendon associated with derangement of the lateral collateral ligament.

Nirschl defined the following progressive stages:
Stage 1 - Inflammatory changes that are reversible
Stage 2 - Nonreversible pathologic changes to origin of the ECRB muscle
Stage 3 - Rupture of ECRB muscle origin
Stage 4 - Secondary changes such as fibrosis or calcification

Suggested Reading:

Steven J. Thornton, JR. Rogers, WD. Prickett, WR. Dunn, AA. Allen, and JA. Hannafin.
Treatment of Recalcitrant Lateral Epicondylitis With Suture Anchor Repair. The American Journal of Sports Medicine 33:1558-1564 (2005).

Link: http://www.emedicine.com/orthoped/topic510.htm
Created by drk on 02/11/2006 05:19 PM
Last updated by drk on 02/20/2006 05:13 PM
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