Radiographic and Clinical Analysis of Lateral Epicondylitis

Abstract

Purpose: The literature suggests that radiographs may be unnecessary in the initial evaluation of lateral epicondylitis because treatment is rarely altered as a result of the radiographic findings. The most commonly reported radiographic finding is calcification at the lateral epicondyle. Our goal was to perform a quantitative and qualitative analysis of this finding to determine its importance and possible relationship with various clinical factors and patient-reported measures.

Methods: All patients diagnosed with lateral epicondylitis by a single surgeon during a 5-year period were retrospectively reviewed. Age, sex, laterality, hand dominance, pain visual analog scale, duration of symptoms, Quick-Disability of the Arm, Shoulder, and Hand questionnaire score, and history of steroid injection were recorded. Calcifications on standard elbow radiographs, acquired digitally and viewed at 200% magnification on a 24-inch monitor, were characterized by size and relationship with the lateral epicondyle.

Results: We reviewed 245 patients diagnosed with lateral epicondylitis. A total of 115 elbows (47%) demonstrated lateral epicondyle calcifications. Patients with and without calcifications were similar with regard to clinical factors, as were patients with larger or smaller lesions. Eighty-five elbows (35%) had additional radiographic findings. Treatment was not altered by the radiographic findings in any case.

Conclusions: Lateral epicondyle calcifications are much more common in lateral epicondylitis than previously reported, possibly owing to modern digital radiography and magnification, although they do not appear to be related to clinical factors including patient-reported measures. Thus, patients and surgeons should be careful to avoid overinterpretation of such findings. Although radiographs may be helpful in ruling out additional pathology, we did not find other clinically important contributions to the initial evaluation and management of this condition, and thus we do not recommend their routine use.

Type of study/level of evidence: Diagnostic IV.

Keywords: Calcification; lateral epicondylitis; radiographic.