Learning objectives
The learning objectives in this pictorial essay are threefold:
1.
To review the pathogenesis and imaging features of tendon diseases of the elbow.
2.
To describe the imaging anatomy and the merit of each imaging technique in the diagnosis of tendon disease of the elbow.
3.
To discuss the differential diagnosis.
Background
Elbow tendinosis is very frequent in daily practice and is often attributed to overuse or intensive sports activities.
Microtearing occurs during stress on a tendon.
If the stress is repetitive,
there will be no fully repair because of the hypovascular nature of a tendon and the repetitiveness of the stress with new microtearing.
This results in tendinosis and eventually macrotears.
As a reaction to the (micro)tearing of the tendon,
an angiofibroblastic reaction occurs with the formation of scar tissue,
being very vulnerable to repetitive trauma...
Imaging findings OR Procedure Details
Plain films are useful in initial workup to rule out occult fractures or stress fractures of the elbow ( Table 1 ,
Table 2 ,
Table 3 ).
Indirect signs of tendinosis are bone spur formation or soft tissue calcifications at the insertion of the affected tendon.
Plain films have limited role in early disease.
The same indirect signs can be seen on CT scan,
but CT is not preferred as the preferred imaging technique because of radiation restraints.
Ultrasound is the first line examination...
Conclusion
1.
Clinical examination is a prerequisite in the assessment of tendon pathology at the elbow.
2.
Plain films and ultrasound are first choice and usually sufficient for the lateral,
medial and posterior compartment.
Evaluation of the anterior compartment is difficult by ultrasonography.
3.
MRI is useful in case of refractory symptoms,
confounding cases,
for a global overview and for differential diagnosis.
The FABS-position is useful for the evaluation of the distal biceps tendon.
References
1) Walz D.M.,
Newman J.S.,
Konin G.P.,
Ross G.
Epicondylitis: Pathogenesis,
Imaging,
and Treatment.
Radiographics.
2010 Jan;30(1):167-84.
2) Chew M.L.,
Giuffrè B.M.
Disorders of the distal biceps brachii tendon.
Radiographics.
2005 Sep-Oct;25(5):1227-37.
Personal Information
M.
Vansevenant1,2
[email protected]
F.M.
Vanhoenacker1,2,3
[email protected]
J.
De Roeck4
[email protected]
1Department of Radiology
University Hospital of Ghent
De Pintelaan 185
BE-9000 Ghent
Belgium
2Department of Radiology
AZ Sint-Maarten
Leopoldstraat 2
BE-2800 Mechelen
Belgium
3Department of Radiology
University Hospital of Antwerp
Wilrijkstraat 10
BE-2650 Edegem
Belgium
4Department of Radiology
AZ St.-Elisabeth Herentals
Nederrij 133
BE-2200 Herentals
Belgium