57-year-old female with chronic lateral elbow pain and functional limitation. The patient reports loss of strength, pain during handshaking, and inability to return to sport activities such as padel. Previous ultrasound in March 2025 demonstrated a moderate to severe partial mid-tendon tear of the common extensor tendon, moderate to severe tendinopathy, and a small enthesophyte at the common extensor tendon origin. The current ultrasound was performed in July 2026 because of persistent and progressive symptoms.
Follow-up ultrasound examination of the lateral elbow demonstrates persistent enthesophyte or osteophyte formation at the origin of the common extensor tendon.
Compared with the previous examination in March 2025, the previously described partial mid-tendon tear has progressed. It now appears as a full-thickness, partial-width tear of the common extensor tendon. The defect is particularly evident during ultrasound-guided dynamic contraction, where the tendon defect opens and the full tendon thickness is interrupted across part of the tendon width.
Around the site of a previous corticosteroid injection, pigmentary skin change is visible. The surrounding soft tissues near the lateral epicondyle also appear thinner and more atrophic than expected. This appearance may be compatible with local cutaneous and subcutaneous tissue changes after corticosteroid injection.
The overall appearance is consistent with chronic, structurally progressive, and therapy-resistant lateral elbow pathology.
1. Final diagnosis
Progressive chronic lateral elbow tendinopathy with evolution of a previous partial mid-tendon tear into a full-thickness, partial-width tear of the common extensor tendon. The tear is dynamically evident during active contraction. A persistent enthesophyte or osteophyte is present at the common extensor tendon origin. Local pigmentary change and soft tissue atrophy around the previous injection site are compatible with possible corticosteroid-related local tissue change.
2. Differential diagnosis
The primary diagnosis is chronic lateral elbow tendinopathy with progressive tearing of the common extensor tendon. Additional insertional tendinopathy or enthesopathy at the lateral epicondyle may contribute to symptoms, particularly in the presence of the enthesophyte. In cases with persistent pain and marked functional limitation, associated lateral collateral ligament involvement, posterolateral rotatory instability, or radiocapitellar intra-articular pathology should also be considered. The local pigmentary change and soft tissue atrophy are most suggestive of a local post-corticosteroid injection effect, although dermatological causes may be considered clinically.
3. Teaching points
Dynamic ultrasound can be essential for demonstrating clinically relevant tendon defects. In this case, active contraction opens the defect and confirms a full-thickness, partial-width tear that may be less obvious on static imaging. Follow-up comparison is important in chronic lateral elbow tendinopathy, as structural progression from tendinopathy or partial tearing to a larger tendon defect may explain worsening strength loss and persistent load intolerance. Local skin depigmentation and subcutaneous atrophy are recognized potential findings after corticosteroid injection and should be documented when present.
4. Injury/disease information
Chronic lateral elbow tendinopathy, commonly known as tennis elbow, is a degenerative overload-related disorder of the common extensor tendon, often involving the extensor carpi radialis brevis origin. Long-standing cases may show tendon degeneration, enthesophyte formation, partial tearing, neovascularization, and reduced load tolerance. Management depends on symptom severity, tendon integrity, functional impairment, and response to rehabilitation. In progressive full-thickness partial-width tendon tearing with major functional limitation, specialist reassessment and additional imaging such as MRI may be useful to evaluate tendon quality, ligament involvement, and possible intra-articular pathology.
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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