36-year-old patient presenting with lateral elbow pain, aggravated by gripping and wrist extension activities. Symptoms likely related to overload or microtrauma.
Ultrasound examination of the lateral elbow demonstrates a partial tear of the radial collateral ligament complex, involving the region of the common extensor tendon origin.
A focal hypoechoic defect measuring approximately 7.24 × 5.22 mm is identified at the extensor tendon–ligament interface, with disruption of the normal fibrillar architecture.
There is moderate to marked neovascularization on Doppler imaging, indicating an active degenerative and reparative process.
The findings are consistent with a combined ligamentous and tendinous injury at the lateral elbow, likely reflecting a spectrum of lateral epicondylopathy with associated ligament involvement.
1. Final diagnosis
Partial tear of the radial collateral ligament and common extensor tendon origin, with significant neovascularization.
2. Differential diagnosis
Consider isolated lateral epicondylitis (tendinopathy without tear) or a more extensive lateral collateral ligament complex injury. Clinical correlation is required to assess stability.
3. Teaching points
Lateral elbow pain is often multifactorial, involving both the common extensor tendon and the lateral collateral ligament complex. Neovascularization is a key feature of chronic tendinopathy. Identification of a focal defect suggests partial tearing rather than isolated tendinopathy.
4. Injury/disease information
Lateral epicondylopathy is typically caused by repetitive overload of the wrist extensors. In more advanced cases, structural failure can occur, leading to partial tears and involvement of adjacent ligamentous structures. Management is usually conservative, focusing on load management and gradual rehabilitation, although recovery may require prolonged time.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.
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