Ultrasonographic Measurement of Thickness of Extensor Carpai Radialis Brevis Tendons for Lateral Epicondylitis

Byung-Sung Kim; Gyoung-Dae Min; Jang-Gyu Cha; Jae-Sang Lee

doi:10.4055/jkoa.2009.44.5.542

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Kim, Min, Cha, and Lee: Ultrasonographic Measurement of Thickness of Extensor Carpai Radialis Brevis Tendons for Lateral Epicondylitis

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(5): 542-547.

Published online: 23 September 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.5.542

Ultrasonographic Measurement of Thickness of Extensor Carpai Radialis Brevis Tendons for Lateral Epicondylitis

Byung-Sung Kim, M.D., Gyoung-Dae Min, M.D., Jang-Gyu Cha, M.D.^*, Jae-Sang Lee, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.

^*Department of Diagnostic Radiology, Soonchunhyang University College of Medicine, Bucheon, Korea.

Correspondence to Gyoung-Dae Min, M.D. Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, 1174, Jung-dong, Wonmi-gu, Bucheon 402-767, Korea. Tel: +82.32-621-5262, Fax: +82.32-324-9577, kbsos@schbc.ac.kr

Received 31 March 2009 Accepted 13 August 2009

Abstract

Purpose

To evaluate the ultrasonographic measurements of the thickness of the extensor carpai radialis brevis tendons in patients with lateral epicondylitis.

Materials and Methods

Twenty nine patients diagnosed with lateral epicondylitis were examined prospectively. Eight were male and twenty one were female. The mean age was 48 (34-62) years. The average time from the onset of symptoms until the examination was 9 (1-24) months. Eighteen patients did not show improvement in their symptoms after conservative treatment. Six underwent arthroscopic debridement and 4 underwent electric shock wave therapy. Three patients showed calcification on the simple x-ray. The thickness of the extensor carpai radialis brevis tendons on both the lesion and contralateral sides was measured and compared using ultrasonography.

Results

There were no significant differences in age and gender between the thickness of the extensor carpai radialis brevis tendons on the lesion and contralateral sides (p=0.83, 0.25, 0.80, 0.64). The thickness of the extensor carpai radialis brevis tendons on the lesion and contralateral sides were 4.9 mm and 3.2 mm, respectively, and the lesion side was significantly thicker (p<0.001). The best cut off value of the ECRB thickness at its origin was 3.95 mm, which had a sensitivity, specificity and accuracy of 96.6%, 79.3% and 87.9%, respectively.

Conclusion

Sonographic measurements of the thickness of the ECRB tendons are valuable for diagnosing lateral epicondylitis.

Keywords: Elbow, Lateral epicondylitis, Ultrasonography

Figures and Tables

Fig. 1

Receiver operation characteristic curve fitted for sonography as the reference standard. The area under the curve was 0.88 (95% CI, 0.79-0.97).

Fig. 2

A transverse image of extensor carpi radialis brevis tendon of symptomatic 49-year-old man with lateral epicondylitis is shown. The tendon of lesion (left) side is more thickened measuring 0.54 cm than contralateral (right) side measuring 0.31 cm. The ECRB origin (diamond shape area between midline of the radiocapitella joint and top of the capitellum) and scan area (black arrow, oval) for measurement are shown.

Table 1

Thickness of ECRB (Extensor Carpi Radialis Brevis) at Lateral Epicondyle

Table 2

Thickness of ECRB at Lateral Epicondyle between Male and Female

Table 3

Number of Elbows according to the Result

ECRB, extensor carpi radialis brevis.

Table 4

Sensitivity, Specificity and Accuracy of Sonography

ECRB, extensor carpi radialis brevis.

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