Multimodal ultrasound assessment of the injection therapy in lateral epicondylitis: a retrospective observational study

Abstract

Background: At present, there is a dearth of objective methodologies for assessing the effectiveness of treatments for Lateral Epicondylitis (LE). This study examined 73 patients suffering from tennis elbow using a multimodal ultrasound approach and investigated the correlation between pertinent indicators and clinical scores.

Methods: 73 patients diagnosed with unilateral tennis elbow by interventional ultrasound at Zhejiang Rongjun Hospital were included in the study. Ultrasound data of the extensor tendon, as well as VAS (Visual Analog Scale) and MEPS (Mayo Elbow Performance Score) for the affected elbow, were collected before and after a two-week treatment period. The study aimed to compare the alterations in gray-scale ultrasound features, hemodynamic parameters, and elastography scores pre- and post-treatment, and to analyze the correlation between the changes in ultrasound parameters and pain scores.

Results: Following treatment, the effective group exhibited a reduction in both the blood flow grade and elastic score of the extensor tendon. Additionally, the extensor tendon thickness in the effective group diminished to a greater extent than in the ineffective group. The effective group also experienced a higher rate of decrease in blood flow grade and a more pronounced increase in Resistive Index (RI) compared to the ineffective group. The reduction in tendon thickness, the increase in RI, and the improvement in elastic score were all positively correlated with the reduction in VAS scores. Notably, the increase in RI demonstrated the strongest correlation with the decrease in VAS scores.

Conclusions: Multimodal ultrasound plays a significant role in the clinical assessment of treatment outcomes for Lateral Epicondylitis.

Keywords: Elbow; Epicondylitis; Guided; Injection; Intervention; Pain; Tendon; TennisElbow; Ultrasonography.

Fig. 1

Ultrasound-guided injection therapy. Distal-to-proximal approach; white triangles indicate the proximal ends

Fig. 2

Interface between the CET and the forearm fascia, white arrows indicate the injection needle. LE: Lateral Epicondylitis; CET: Common Extensor Tendon

Fig. 3

Ultrasound measurement of CET thickness(The thickness was measured 1 cm from the attachment end of the tendon)

Fig. 4

CET color blood flow imaging, The vascular signals visualized with the color Doppler involve the most superficial portion of the tendon.LE: Lateral Epicondylitis

Fig. 5

Measurement of RI in the CET internal artery

Fig. 6

CET strain elastography, The radial collateral ligament(White arrow) appears blue compared to CET which appears green. LE: Lateral Epicondylitis. CET: common extensor tendon