Management of Lateral Epicondylitis
(Part 3)
Cases of Lateral Epicondylitis (LE) may be confirmed via history inquiry and physical examinations.
The medical history contents usually include patient’s occupation, dominant hand, daily behaviors and habits, duration of symptoms, date of prior episodes, number of recurrences, inducing or aggravating factors, treatment modalities, and tobacco use.
It is also important to note that the duration of symptoms and the number of occurrences and recurrences are important. These are two key important factors in order to find out the stage of LE.
When diagnosing LE, any test that is able to trigger the symptoms of LE can be considered a good way to test and eventually diagnose LE.
There are special tests that are usually performed during the examination, such as the chair test, Cozen’s test, and Mill’s test.
Grip weakness has also been considered as a test to diagnose LE.
However, if symptoms cannot be seen based on examination and history, diagnostic imaging may be used.
Imaging may reveal some useful information leading to the discovery of bone diseases, such as arthropathy, osteochondral defects, loose bodies, and calcifications.
Ultrasound is seen as better and relatively cost-effective imaging method for diagnosing LE.
Ultrasound can be used for identifying degenerative changes of the tendons attached to the region of the lateral epicondyle, which includes bone irregularities, calcific deposit, thickening, thinning, and tears of affected tendons or capsule.
Moreover, neovascularization can also be detected through ultrasound.
Compared with ultrasound, magnetic resonnamce imgining (MRI) can provide a better view of the complete anatomical structures of the lateral epicondyle.
An elbow MRI may show signs of abnormal thickening tendon and capsule and increased signal intensity within the common extensor origin.
The MRI may help identify partial or full-thickness tears of the extensor carpi radialis brevis (ECRB), which may lead to the need for surgery.
Compared with ultrasound, MRI may not be able to determine the overall extent and size of tendon tearing. MRI can be used to find out intra-articular pathology.
MRI is not recommended due to its cost and the inconsistence of symptoms with imaging findings.
LE is the leading cause of elbow pain; yet similar pain may be caused by other health problems and should be carefully diagnosed.
Elbow pain may be caused by cervical radiculopathy, frozen shoulder, radial tunnel syndrome, lateral plica syndrome of the elbow, posterolateral elbow instability, and inflammatory edema of the elbow muscle, among others.
Elbow pain may also be caused by low-grade infection or other inflammatory diseases, such as rheumatoid arthritis.