Anatomy and Sonographic Examination for Lateral Epicondylitis: EURO-MUSCULUS/USPRM Approach

Ultrasound-guided tenotomy of the common extensor tendon in the elbow: a cadaveric investigation

OBJECTIVE

This study aimed to evaluate the efficacy and safety of a novel ultrasound-guided percutaneous tenotomy technique for treating chronic tendinosis of the common extensor tendon (CET) in the elbow (lateral epicondylitis).

METHODS

The study was conducted on 25 elbows from 13 cadavers without prior local injuries. Each CET tenotomy was performed using a Mikro 64 scalpel under ultrasound guidance to ensure precision and safety. Key anatomical structures, including the lateral collateral ligament (LCL), radial nerve, and posterior antebrachial cutaneous nerve, were monitored to assess safety margins and detect potential complications.

RESULTS

In the 20 evaluated cases, the mean distance from the CET section to the radial epicondyle (DET) was 5.86 mm (range 5.96-12.8 mm), while the distance to the proximal LCL margin (DELCL) averaged 8.62 mm (range - 0.96-6.82 mm), yielding a confident tenotomy length of 2.76 mm. Partial LCL injury occurred in four cases without affecting joint stability, and no nerve injuries were observed. Incomplete CET sections were found in four cases, with residual fibers primarily along the medial and lateral margins.

CONCLUSION

The ultrasound-guided percutaneous tenotomy technique demonstrated safety and effectiveness in an anatomical setting. This minimally invasive approach may offer a viable surgical alternative for refractory lateral epicondylitis, minimizing the risk of complications and promoting a shorter recovery period.

Diagnostic Musculoskeletal Ultrasound for the Evaluation of the Lateral Elbow: Implications for Rehabilitation Providers

Musculoskeletal ultrasound (MSKUS) has emerged as a valuable diagnostic tool in the evaluation and management of lateral elbow pathologies. This imaging modality provides high-resolution, dynamic visualization of superficial soft tissue structures, making it particularly advantageous for assessing conditions such as lateral epicondylitis (tennis elbow), ligamentous injuries, radial tunnel syndrome, and other common disorders. This article reviews the utility of MSKUS for rehabilitation providers, focusing on its role in accurately identifying pathoanatomical changes, guiding treatment strategies, and monitoring therapeutic outcomes. Specific emphasis is placed on the integration of diagnostic ultrasound in clinical practice, imaging techniques, and its advantages compared to other modalities. By enhancing diagnostic accuracy and facilitating targeted interventions, MSKUS serves as a critical adjunct in the comprehensive care of lateral elbow conditions.

Musculoskeletal disorders in padel: from biomechanics to sonography

Padel is a racket sport, combining high-frequency and low-intensity athletic gestures, that has been gaining growing scientific interest in recent years. Musculoskeletal injuries are very common among padel players with an incidence rate of 3 per 1000 h of training and 8 per 1000 matches. To the best of our knowledge, a comprehensive collection describing the most common sonographic findings in padel players with musculoskeletal injuries is lacking in the pertinent literature. In this sense, starting from the biomechanical features of padel-specific gestures we have reported the ultrasonographic patterns of most frequent injuries involving the upper limb, the trunk, and the lower limb. Indeed, comprehensive knowledge of the biomechanical and clinical features of musculoskeletal injuries in padel is paramount to accurately perform a detailed ultrasound examination of the affected anatomical site. So, the present investigation aims to provide a practical guide, simple and ready-to-use in daily practice, to optimize the sonographic assessment of padel players by combining it with the clinical findings and the biomechanical features of athletic gestures.

Ultrasound-guided injection of the elbow: Cadaveric description for the proximal to distal approach

BACKGROUND

Ultrasound (US) guided intra-articular elbow injections are commonly performed in clinical practice.

OBJECTIVE

To describe a proximal to distal approach for US-guided intra-articular elbow injection.

DESIGN

Cadaveric study.

SETTINGS

Academic institution.

METHODS

Both elbows of a single cadaver were injected with green-colored water-diluted latex dye using the US-guided proximal to distal approach. In the left elbow, the needle was kept in situ; in the right elbow, the needle was removed. Subsequently, a layer-by-layer anatomical dissection was performed in both elbows.

MAIN OUTCOME MEASURES

Presence and distribution of the latex dye and location of the needle tip within the elbow joint capsule.

RESULTS

Anatomical dissection of both elbows confirmed the correct intra-articular position of the needle tip in the left elbow as well as correct placement of the latex dye bilaterally. During layer-by-layer dissection of the left elbow, the position of the radial nerve was observed anterior to the needle.

CONCLUSIONS

This cadaveric observation demonstrated that the US-guided proximal to distal approach is a convenient technique to access the elbow joint. Compared to the previously described techniques, the in-plane, proximal to distal approach may provide excellent needle visibility during the entire procedure, precisely targeting the articular space. The preliminary data need to be validated in additional clinical studies.

Ultrasonography for Injecting (Around) the Lateral Epicondyle: EURO-MUSCULUS/USPRM Perspective

Lateral epicondylitis (LE) is a very common and painful condition seen in the daily practice of musculoskeletal physicians. Ultrasound-guided (USG) injections are commonly performed to manage the pain, promote the healing phase, and plan a tailored rehabilitation treatment. In this aspect, several techniques were described to target specific pain generators i the lateral elbow. Likewise, the aim of this manuscript was to extensively review those USG techniques together with the patients' pertinent clinical/sonographic features. The authors believe that this literature summary could also be refined as a practical, ready-to-use guide for planning the USG interventions of the lateral elbow in clinical practice.

[CME Sonography 107: Ultrasound Elbow Cases]

CME Sonography 107: Ultrasound Elbow Cases Abstract. In this article, we discuss exemplary sonographic pathologies at the anterior, lateral, medial, and posterior elbow, highlighting important structures that should be systematically examined in the corresponding elbow region.