Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 7;16(7):e0254037.
doi: 10.1371/journal.pone.0254037. eCollection 2021.

Radiocapitellar incongruity of the radial head in magnetic resonance imaging correlates with pathologic changes of the lateral elbow stabilizers in lateral epicondylitis

Yeun Soo Kim  1 , Sung Taeck Kim  2 , Kyoung Hwan Lee  2 , Joong Mo Ahn  3 , Hyun Sik Gong  2
Affiliations

Radiocapitellar incongruity of the radial head in magnetic resonance imaging correlates with pathologic changes of the lateral elbow stabilizers in lateral epicondylitis

Yeun Soo Kim et al. PLoS One. .

Abstract

Objective: Post-traumatic posterolateral rotatory instability (PLRI) can be shown as radiocapitellar incongruity or posterior translation (PT) of the radial head in magnetic resonance imaging (MRI). We aimed to evaluate whether PT correlated with pathologic changes of lateral elbow stabilizers in patients with lateral epicondylitis.

Materials and methods: In MRIs of 160 patients with lateral epicondylitis, we measured PT of the radial head in the sagittal images. We qualitatively graded five lesions of the lateral elbow structures that included common extensor tendon (CET) lesion (grade 1-3), lateral collateral ligament complex (LCLC) insufficiency (grade 0-2), and absence or presence of bone marrow signal change, osteochondral lesion, and calcification. We analyzed whether the PT correlated with pathologic changes of the lateral elbow stabilizers and evaluated the diagnostic value of the PT for severe lesions.

Results: The average PT was 1.9 mm. The PT correlated with both the CET lesion (p < 0.001) and LCLC insufficiency (p < 0.001). The optimal cutoff values of the PT for grade 3 CET lesion and grade 2 LCLC lesion were 2.6 and 2.8 mm, respectively. When potential PLRI was defined as the PT of > 3.4mm as suggested for post-traumatic PLRI, 21 patients had potential PLRI. The positive predictive values of the PT > 3.4mm were 76% for grade 3 CET lesions and 67% for grade 2 LCLC insufficiency.

Conclusion: This study demonstrates that PT of the radial head correlates with pathological changes of the lateral elbow stabilizers. As radiocapitellar incongruity is easy to measure quantitatively, it can be used for screening potential PLRI in patients with lateral epicondylitis.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
a. 41-year-old woman with tendinosis of the common extensor tendon (CET). b. 59-year-old man with intermediate-grade partial tear of the CET and partial tear of the lateral collateral ligament complex (LCLC). c. 48-year-old woman with high-grade partial tear of the CET and partial tear of the LCLC. d. 54-year-old woman with near-complete tear of the CET and LCLC.
Fig 2
Fig 2. Measurement of radiocapitellar incongruity of the radial head.
In sagittal image through the center of the radial head, the center of the capitellum (C) and the longitudinal axis of the proximal radius (R) were marked. The minimum distance between (C) and (R) was measured.
Fig 3
Fig 3. Receiver operating characteristic curve analysis of posterior translation of the radial head for grade 3 common extensor tendon lesion.
Fig 4
Fig 4. Receiver operating characteristic curve analysis of posterior translation of the radial head for grade 2 lateral collateral ligamentous complex lesion.
Fig 5
Fig 5. The incidence of potential posterolateral rotatory instability in accordance with the severity of the magnetic resonance imaging parameters.
PLRI, Posterolateral Rotatory Instability; CET, Common Extensor Tendon; LCLC, Lateral Collateral Ligament Complex.
See this image and copyright information in PMC

References

    1. Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832–9. Epub 1979/09/01. . - PubMed
    1. Kalainov DM, Cohen MS. Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases. J Bone Joint Surg Am. 2005;87(5):1120–5. Epub 2005/05/04. doi: 10.2106/JBJS.D.02293 . - DOI - PubMed
    1. Kwak SH, Lee SJ, Jeong HS, Do MU, Suh KT. Subtle elbow instability associated with lateral epicondylitis. BMC Musculoskelet Disord. 2018;19(1):136. Epub 2018/05/08. doi: 10.1186/s12891-018-2069-8 ; PubMed Central PMCID: PMC5938800. - DOI - PMC - PubMed
    1. Morrey BF. Reoperation for failed surgical treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg. 1992;1(1):47–55. Epub 1992/01/01. doi: 10.1016/S1058-2746(09)80016-5 . - DOI - PubMed
    1. Shim JW, Yoo SH, Park MJ. Surgical management of lateral epicondylitis combined with ligament insufficiency. J Shoulder Elbow Surg. 2018;27(10):1907–12. Epub 2018/09/02. doi: 10.1016/j.jse.2018.06.011 . - DOI - PubMed

Publication types

MeSH terms