Lateral Epicondylitis and Lateral Collateral Ligament Injury

Tennis Elbow Secrets Revealed

Tennis Elbow Secrets Revealed

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Lateral epicondylitis, also called tennis elbow, is caused by degeneration and tearing of the common extensor ten-don.22 This condition often occurs as a result of repetitive sports-related trauma to the tendon, although it is seen far more commonly in nonathletes.9 In the typical patient, the degenerated extensor carpi radialis brevis tendon is partially avulsed from the lateral epicondyle.22 Scar tissue

Epizondylus RadialRadial Head Scar

FIGURE 4.4. Clinically suspected tennis elbow in a patient who did not respond to a local steriod injection. A STIR coronal image (A) and a T2-weighted axial image (B) reveal a completely normal common extensor tendon (open arrows) and increased signal within the adjacent extensor carpi radialis longus muscle (solid arrows) secondary to a recent steroid injection. Abnormal signal may persist for weeks after an injection and be mistaken for primary muscle pathology on MRI.

forms in response to this partial avulsion, which then is susceptible to further tearing with repeated trauma. Recent histologic studies have shown angiofibroblastic tendi-nosis with a lack of inflammation in the surgical specimens of patients who have lateral epicondylitis; this suggests that the abnormal signal seen on MR images is secondary to tendon degeneration and repair rather than tendinitis.14,17 Local steroid injections commonly are used to treat lateral epicondylitis and may increase the risk of tendon rupture.23,24 Signal alteration in the region of a local steroid injection should not be confused for primary muscle abnormality on MRI (Fig. 4.4).

Overall, 4% to 10% of cases of lateral epicondylitis are resistant to nonoperative therapy14'25; MRI is useful in assessing the degree of tendon damage in such cases. Tendinosis and tearing typically involve the extensor carpi radialis brevis portion of the common extensor tendon anteriorly. Degenerative tendinosis is manifested by normal to increased tendon thickness, with increased signal intensity on T1-weighted images that is not as bright as fluid on properly windowed T2-weighted images. Partial tears are characterized by thinning of the tendon that is outlined by adjacent fluid on the T2-weighted images (Fig. 4.5). Complete tears may be diagnosed on MRI by identifying a fluid-filled gap separating the tendon from its adjacent bony attachment site.

At surgery for lateral epicondylitis, 97% of the tendons appear scarred and edematous and 35% have macroscopic tears.22 MRI is useful in identifying high-grade partial tears and complete tears that are unlikely to improve with rest and repeated steroid injections. In addition to determining the degree of tendon damage, MRI also provides a more global assessment of the elbow and is therefore able to detect additional abnormal conditions that may explain the lack of a therapeutic response. For example, unsuspected ruptures of the lateral collateral ligament complex may occur in association with tears of the common extensor tendon (Fig. 4.6). Morrey recently reported on a series of 13 patients who underwent reoperation for failed lateral epicondylitis surgery; stabilization procedures were required in 4 patients with either iatrogenic or unrecognized lateral ligament insufficiency.26 Ia-trogenic tears of the lateral ulnar collateral ligament (LUCL) may occur secondary to an overly aggressive release of the common extensor tendon.27 Operative release of the extensor tendon may further destabilize the elbow

Epizondylus Radial

FIGURE 4.5. Lateral epicondylitis in a 30-year-old tennis player. A T2-weighted coronal image reveals increased signal and attenuation of the common extensor tendon (large arrow) compatible with a partial tear. The underlying LUCL (curved arrow) is thickened and mildly increased in signal compatible with degeneration.

FIGURE 4.5. Lateral epicondylitis in a 30-year-old tennis player. A T2-weighted coronal image reveals increased signal and attenuation of the common extensor tendon (large arrow) compatible with a partial tear. The underlying LUCL (curved arrow) is thickened and mildly increased in signal compatible with degeneration.

FIGURE 4.6. A 50-year-old tennis player with symptoms of lateral epicondylitis. Tl-weighted (A) and STIR (B) coronal images reveal detachment of the common extensor tendon from the lateral epicondyle (straight arrow). The underlying LUCL is also torn from its attachment site on the humerus (curved arrow).

when rupture of the LUCL and subtle associated instability are not recognized clinically. MRI can reveal concurrent tears of the LUCL and common extensor tendon in patients who have lateral epicondylitis and isolated LUCL tears in patients who have posterolateral rotatory instability. Moreover, the lack of a significant abnormality involving the common extensor tendon on MRI may prompt consideration of an alternative diagnosis, such as radial nerve entrapment that can mimic or accompany lateral epicondylitis.28,29

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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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Responses

  • mareta
    What causes tears in the common extensor tendon and collateral ligament?
    29 days ago
  • raffaella
    How to treat left bicipital tear with left lateral epicondylitis?
    10 days ago

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