Diagnostic ultrasound imaging for lateral epicondylalgia: a case control study

Heales, Luke James, Broadhurst, Nathan, Mellor, Rebecca, Hodges, Paul William and Vicenzino, Bill (2014) Diagnostic ultrasound imaging for lateral epicondylalgia: a case control study. Medicine and Science in Sports and Exercise, 46 11: 2070-2076. doi:10.1249/MSS.0000000000000345


Author Heales, Luke James
Broadhurst, Nathan
Mellor, Rebecca
Hodges, Paul William
Vicenzino, Bill
Title Diagnostic ultrasound imaging for lateral epicondylalgia: a case control study
Journal name Medicine and Science in Sports and Exercise   Check publisher's open access policy
ISSN 0195-9131
1530-0315
Publication date 2014-11-01
Year available 2014
Sub-type Article (original research)
DOI 10.1249/MSS.0000000000000345
Volume 46
Issue 11
Start page 2070
End page 2076
Total pages 7
Place of publication Lippincott Williams & Wilkins
Publisher Philadelphia, PA, United States
Language eng
Formatted abstract
Introduction: Lateral epicondylalgia (LE) is clinically diagnosed as pain over the lateral elbow that is provoked by gripping. Usually, LE responds well to conservative intervention; however, those who fail such treatment require further evaluation, including musculoskeletal ultrasound. Previous studies of musculoskeletal ultrasound have methodological flaws, such as lack of assessor blinding and failure to control for participant age, sex, and arm dominance. The purpose of this study was to assess the diagnostic use of blinded ultrasound imaging in people with clinically diagnosed LE compared with that in a control group matched for age, sex, and arm dominance.

Methods: Participants (30 with LE and 30 controls) underwent clinical examination as the criterion standard test. Unilateral LE was defined as pain over the lateral epicondyle, which was provoked by palpation, resisted wrist and finger extension, and gripping. Controls without symptoms were matched for age, sex, and arm dominance. Ultrasound investigations were performed by two sonographers using a standardized protocol. Grayscale images were assessed for signs of tendon pathology and rated on a four-point ordinal scale. Power Doppler was used to assess neovascularity and rated on a five-point ordinal scale.

Results: The combination of grayscale and power Doppler imaging revealed an overall sensitivity of 90% and specificity of 47%. The positive and negative likelihood ratios for combined grayscale and power Doppler imaging were 1.69 and 0.21, respectively.

Conclusions: Although ultrasound imaging helps confirm the absence of LE, when findings are negative for tendinopathic changes, the high prevalence of tendinopathic changes in pain-free controls challenges the specificity of the measure. The validity of ultrasound imaging to confirm tendon pathology in clinically diagnosed LE requires further study with strong methodology.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Health and Rehabilitation Sciences Publications
 
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