Sonographic probe induced tenderness for lateral epicondylitis: an accurate technique to confirm the location of the lesion

The purpose of this study is to evaluate the hypothesis that ultrasonographic probe-induced tenderness is a useful adjunct to the simple sonography in confirming the location of the pathology within the extensor carpi radialis brevis tendon in patients with lateral epicondylitis of the elbow. We conducted a case controlled study by evaluating 27 consecutive patients in the age group of 37–59 years (median 44) who had typical symptoms of lateral epicondylitis and a visual analogue score of more than 4 and evaluating a same number of asymptomatic healthy volunteers in the age group of 37–59 years (median 43) by means of ultrasound examination of the lateral elbow in a period of 5 months from 2007 to 2008. When we identified sonographic anechoic or hypoechoic lesions within the common extensor tendon we compressed it with the ultrasound probe to elicit tenderness so as to confirm the site of lesion within the affected tendon. We observed that the abnormal lesion detected by ultrasonography corresponded to the point of maximal tenderness when compressed by the probe in all the symptomatic patients. We therefore conclude that as it is essential to accurately detect the lesion within the extensor carpi radialis brevis for the purpose of diagnosis and treatment of lateral epicondylitis of elbow the technique of inducing tenderness at site of abnormal shadow on ultrasound within the extensor carpi radialis brevis tendon improves the accuracy of identifying the site of lesion, prevents the misinterpretation of anisotropy as pathological lesion and also can be useful to maximize the efficacy of interventions aimed in treating the lateral epicondylitis.