Common Extensor Tendinopathy Of The Elbow

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Common Extensor Tendinopathy Of The Elbow

Authors, Editors, Case Information Author: Melinda Ng, MD Affiliation: Travis Sports Medicine Fellowship, David Grant Medical Center Co Author(s): Carlton J. Covey Senior Editor: Timothy Yu, MD Clinical Vignette: A 48-year-old right-hand-dominant male presented with a 1-year history of persistent right lateral elbow pain despite completing 6 months of physical therapy, modified activity, and relative rest. His exam was notable for tenderness to palpation over the lateral common extensor tendon and pain with resisted wrist extension and middle finger extension. Type of Probe Used: 4-12 MHz linear array transducer Unlabeled Long Axis View of the Common Extensor Tendon Origin Unlabeled Long Axis View of the Common Extensor Tendon Origin Unlabeled Long Axis View of the Common Extensor Tendon Origin with Color Doppler Unlabeled Long Axis View of the Common Extensor Tendon Origin with Color Doppler demonstrating increased neovascularity Labeled Long Axis View of the Common Extensor Tendon Origin Labeled Long Axis View of the Common Extensor Tendon Origin demonstrating heterogenous echogenicity and cortical irregularity with enthesopathic changes at the lateral epicondyle. Unlabeled Short Axis View of the Common Extensor Tendon Origin Unlabeled Short Axis View of the Common Extensor Tendon Origin Labeled Short Axis View of the Common Extensor Tendon Origin Labeled Short Axis View of the Common Extensor Tendon Origin showing enthesophytes and an area of hypoechogenicity, suggesting partial thickness tearing Interpretation Image Interpretation: The common extensor tendon demonstrated loss of fibrillar structure, heterogenous echogenicity, increased vascularity on Doppler, and enthesopathic changes at the lateral epicondyle, which is consistent with lateral elbow tendinopathy. The common extensor tendon origin is slightly hypoechoic, suggesting partial thickness tearing. Teaching Pearl: Lateral elbow tendinopathy is typically seen at the common extensor tendon origin on the lateral epicondyle. Ultrasound findings include tendon thickening or hypoechogenicity, loss of the normal fibrillar pattern, enthesopathy, partial tearing, calcification, and possible Doppler hyperemia. When symptoms are atypical or persistent, consider assessing the radial collateral ligament complex, radiocapitellar joint, and deep radial nerve as well. References: 1. Ricci V, Cocco G, Mezian K, et al. Anatomy and sonographic examination for lateral epicondylitis: EURO-MUSCULUS/USPRM approach. Am J Phys Med Rehabil. 2023;102(4):300-307. doi:10.1097/PHM.0000000000002090 2. Dones VC III, Grimmer K, Thoirs K, Suarez CG, Luker J. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging. 2014;14:10. doi:10.1186/1471-2342-14-10 3. Manske RC, Wolfe C, Page P, Voight M. Diagnostic musculoskeletal ultrasound for the evaluation of the lateral elbow: implications for rehabilitation providers. Int J Sports Phys Ther. 2025;20(1):137-143. doi:10.26603/001c.127528
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Common Extensor Tendon Origin

Unlabeled Long Axis View of the Common Extensor Tendon Origin with Color Doppler

Labeled Long Axis View of the Common Extensor Tendon Origin

Unlabeled Short Axis View of the Common Extensor Tendon Origin

Labeled Short Axis View of the Common Extensor Tendon Origin

Interpretation

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