The ultrasound elastography findings in lateral epicondylitis in comparison with healthy individuals

Objectives: To evaluate the ability of strain sonoelastography (SEL) in diagnosing lateral epicondylitis (LE) and to asses clinical and diagnostic efficacy of strain SEL in patients with clinically confirmed LE and in healthy volunteers. Methods: Strain SEL was performed on 110 patients with clinical symptoms of LE and on 56 healthy participants. The common extensor tendon (CET) was evaluated with gray-scale and color Doppler ultrasonography (CDUS). The stiffness and the elasticity of the CET was divided into 2 main types and 2 subtypes as a spectrum ranging from hard for 1a to soft for 2b. Results: The thickness of the CET in patients with LE (6.3±1.06 mm) were remarkably thicker than in healthy participants (3.8±0.62 mm) (p<0.001). There were negative significant correlations between the thickness of the CET and lower and mean strain ratios (SR) (rs= [–0.666], p<0.001 for lower SR and rs= [–0.358], p<0.001 for mean SR). Thickness of the CET varied between the groups of elastographic patterns (p<0.001). The SR of tendon in patients with LE (6.68±2.49 mm) were remarkably lower than in healthy participants (11.16±4.88 mm) (p<0.001). The SR of tendon in patients with LE also varied significantly between the groups of elastographic patterns (p<0.001). Conclusion: Strain SEL is a promising sonographic technique for musculoskeletal imaging to differentiate thickening and softening of CET in LE. SR and SEL pattern findings are compatible with gray scale ultrasound and CDUS findings.