53-year-old [male/female] patient with lateral elbow pain clinically suggestive of lateral epicondylalgia, also known as tennis elbow. Symptoms are provoked by [gripping/wrist extension/supination/sport or work-related loading]. Ultrasound examination was focused on the lateral aspect of the elbow.
Ultrasound of the lateral elbow demonstrates mild tendinopathic changes of the common extensor tendon at its origin near the lateral epicondyle. The tendon shows focal disturbance of the normal fibrillar architecture, consistent with lateral epicondylalgia.
In the central portion of the common extensor tendon, just distal to the lateral epicondyle, there is a well-defined elongated partial tear measuring 4.13 mm in length and 3.60 mm in width. The lesion is rounded and sharply demarcated, with interruption of the fibrillar tendon structure. No complete tendon rupture is seen.
There are no sonographic signs of neovascularisation within or around the tendon tear. Based on the provided findings, there is no clear evidence of associated lateral collateral ligament complex injury.
1. Final diagnosis
Lateral epicondylalgia due to mild tendinopathy of the common extensor tendon, with a distinct central partial tendon tear measuring 4.13 x 3.60 mm, located just distal to the lateral epicondyle. No sonographic evidence of complete rupture or neovascularisation.
2. Differential diagnosis
A lateral collateral ligament complex injury is less likely but should be considered in the presence of traumatic onset, lateral elbow instability, or symptoms during varus stress. Posterior interosseous nerve entrapment or radial tunnel syndrome is also less likely, but may be considered when pain is deeper, more anterolateral, or neurogenic in character.
3. Teaching points
In lateral epicondylalgia, ultrasound may show tendinopathy of the common extensor tendon with focal loss of the normal fibrillar pattern. A central, sharply demarcated tendon defect supports the diagnosis of a partial intratendinous tear. Dynamic assessment and correlation with pain location are important to exclude associated lateral instability or nerve-related pain. Absence of neovascularisation does not exclude clinically relevant tendinopathy or partial tearing.
4. Injury/disease information
Lateral epicondylalgia is usually an overload-related tendinopathy of the common extensor tendon, most often involving the extensor carpi radialis brevis component. Initial treatment is generally conservative, with temporary reduction of provocative load, ergonomic modification, and progressive tendon loading. In the presence of a partial tear, high peak load, heavy gripping, and explosive wrist extension or supination should be temporarily avoided. Rehabilitation may include isometric pain modulation followed by gradual eccentric and concentric loading of the wrist extensors, combined with shoulder and scapular kinetic chain training. If symptoms persist despite adequate conservative treatment, ultrasound-guided intervention such as fenestration, needling, or PRP may be considered. Corticosteroid injection should be used cautiously in tendinopathy with partial tearing because of potential adverse effects on tendon quality and recurrence risk.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at EchoConsult in Roermond, the Netherlands.
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