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Marotta N, de Sire A, Lippi L, Moggio L, Mondardini P, Sgro M, Bartalotta I, Zito R, Giroldini T, Invernizzi M, Longo UG, Ammendolia A. Effectiveness of High-Power Laser Therapy via Shear Wave Speed Analysis on Pain and Functioning in Patients with Lateral Epicondylitis: A Proof-of-Concept Study. J Clin Med 2024; 13:2014. [PMID: 38610779 PMCID: PMC11012724 DOI: 10.3390/jcm13072014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Lateral epicondylitis (LE) causes lateral elbow pain due to the overuse of the common extensor tendon. Several therapies have been proposed for pain relief and functional recovery, including physical therapy, minimally invasive injection approaches, and physical agent modalities such as laser therapy. Methods: Our study evaluates the impact of high-power laser therapy (HPLT) on pain and functioning. The HPLT protocol consists of 10 daily sessions using a LASERIX PRO device. The healthy elbow of each participant was also considered as a control group. The outcomes assessed were the Numerical Rating Scale (NRS) for pain, QuickDASH questionnaire for functionality, and shear wave velocity (SWS) through ultrasonography. Assessments were conducted at baseline (T0), post-treatment (T1), and 2-week follow-up (T2). Results: Sixteen participants (81.2% male, mean age 40.4 ± 5.53 years) completed the study. Post-treatment, pain significantly decreased (NRS: T0 6.13 ± 0.96; T1 2.75 ± 1.69; p < 0.001), functionality improved (QuickDASH: T0 69.88 ± 10.75; T1 41.20 ± 3.78; p < 0.001), and shear wave velocity increased (SWS (m/s): T0 1.69 ± 0.35; T1 2.56 ± 0.36; p < 0.001). Conclusions: At the 2-week follow-up, pain relief was maintained, and shear wave velocity showed no further significant change. Shear wave velocity assessments might be considered a useful diagnostic tool. However, further research is needed to support the role of HPLT and shear wave velocity in the rehabilitation management of LE.
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Affiliation(s)
- Nicola Marotta
- Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, 1085 Budapest, Hungary;
| | - Lucrezia Moggio
- Rehabilitation Unit, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Paolo Mondardini
- Department of Sport Science, Università di Bologna, 40100 Bologna, Italy
| | - Maria Sgro
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Isabella Bartalotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Roberta Zito
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Teobaldo Giroldini
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy;
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (I.B.); (R.Z.); (T.G.)
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Nambi G, Alghadier M, Verma A, Aldhafian OR, Alshahrani NN, Saleh AK, Omar MA, Hassan TGT, Ibrahim MNA, El Behairy HF. Clinical and radiological effects of Corticosteroid injection combined with deep transverse friction massage and Mill's manipulation in lateral epicondylalgia-A prospective, randomized, single-blinded, sham controlled trial. PLoS One 2023; 18:e0281206. [PMID: 36780557 PMCID: PMC9925075 DOI: 10.1371/journal.pone.0281206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The knowledge about the effective implementation of corticosteroid injection (CS) with deep transverse friction massage (DTFM) and Mill's manipulation (MM) on clinical and radiological changes (Magnetic resonance imaging-MRI and Ultra sound) in lateral epicondylalgia (LE) is lacking. Therefore, the objective of this study is proposed to find and compare the effects of corticosteroid injection (CS) DTFM and Mill's manipulation on clinical and radiological changes in lateral epicondylalgia. DESIGN, SETTING, PARTICIPANTS Randomized, single-blinded, controlled study was conducted on 60 LE participants at university hospital. The active MM group (n = 30) received corticosteroid injection with DTFM and active Mill's manipulation (MM) three sessions a week for 4 weeks and the sham MM group received corticosteroid injection with sham manipulation. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were percentage of injury measured by MRI and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life which were measured at 4 weeks, 8weeks and at 6 months follow up. RESULTS The between-group difference in pain intensity at 4 weeks was 1.6 (CI 95% 0.97 to 2.22), which shows improvement in the active group than sham group. The similar effects have been noted after 8 weeks and at 6 months 2.0 (CI 95% 1.66 to 2.33) follow up in pain intensity. Similar improvements were also found on percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life (p = 0.001). CONCLUSION Corticosteroid injection with DTFM and Mill's manipulation was superior to sham group for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with lateral epicondylalgia. TRIAL REGISTRATION Clinical trial registration: CTRI/2020/05/025135 trial registered prospectively on 12/05/2020. https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/05/025135.
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Affiliation(s)
- Gopal Nambi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- * E-mail:
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Anju Verma
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- Faculty of Medicine and Health, Department of Exercise and Sports Sciences, School of Health Sciences, University of Sydney, New South Wales, Australia
| | - Osama R. Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Naif N. Alshahrani
- Orthopedic Surgery Department, King Fahad medical city, Ministry of Health, Riyadh, Saudi Arabia
| | - Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | - Mohamed A. Omar
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | - Tohamy G. T. Hassan
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | | | - Hassan Fathy El Behairy
- Faculty of Medicine for Girls, Al-zhraa University Hospital, Al-Azhar University, Cairo, Egypt
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Müller PE, Niethammer TR. [Sports injuries : What type of imaging is required?]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:235-240. [PMID: 36757482 DOI: 10.1007/s00117-023-01121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Imaging is of great importance in sports injuries, since the indication for conservative and surgical therapy depends on precise knowledge of the extent of the damage. OBJECTIVES Typical sports injuries and their imaging requirements are to be presented as examples. CONCLUSIONS In order to detect the often subtle pathologies, imaging must be adapted to the clinical diagnosis that is specifically suspected.
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Affiliation(s)
- Peter E Müller
- Schwerpunkt Knie & Sport, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Thomas R Niethammer
- Schwerpunkt Knie & Sport, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
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Page P, Manske RC, Voight M, Wolfe C. MSK Ultrasound - An IJSPT Perspective. Int J Sports Phys Ther 2023; 18:1-10. [PMID: 36793557 PMCID: PMC9897034 DOI: 10.26603/001c.68184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
MSK ultrasound is a valuable imaging technique which has become increasingly popular in recent years. This efficient technique proves beneficial in a variety of ways. MSK ultrasound effectively streamlines the process by enabling practitioners to securely and accurately image and assess structures all in one simple step. By allowing healthcare providers to access critical information quickly and conveniently, MSK ultrasound can help identify conditions early when interventions are most effective. Moreover, it may be able to shorten diagnostic times and reduce costs through more cost-effective use of resources such as imaging and laboratory testing. Furthermore, MSK ultrasound can provide additional insights into musculoskeletal anatomy and help improve patient care and outcomes. In addition, utilizing this method reduces exposure to radiation and provides enhanced patient comfort with its quick scan duration. MSK ultrasound has a high potential to provide quick and accurate diagnosis of MSK disturbances when used correctly. As clinicians become more comfortable and familiar with this technology, we will continue to see its use expand for various MSK assessments. In this commentary we'll explore how ultrasound can be used in physical therapy, specifically for musculoskeletal assessment. We'll also look at some of the potential benefits and limitations of using ultrasound in PT practice.
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Affiliation(s)
- Phil Page
- Doctor of Physical Therapy Program Franciscan University
| | | | | | - Chris Wolfe
- School of Physical Therapy Belmont University
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Greene C, Droppelmann G, García N, Jorquera C, Verdugo A. A New Test for the Advanced Diagnosis of Lateral Elbow Tendinopathy with Concomitant Intrasubstance Tear: Failure to Resist Extension Effort (the Free Test). Orthop Res Rev 2022; 14:495-503. [PMID: 36606066 PMCID: PMC9809378 DOI: 10.2147/orr.s364050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background Lateral elbow tendinopathy (LET) is one of the most common causes of musculoskeletal pain. The diagnosis is based on the clinical history and different physical maneuvers. Ultrasound (US) is a complementary diagnostic method to detect degenerative tendon changes and intrasubstance tears (IST). To date, there is no available physical maneuver to identify an IST in patients with LET. Aim To evaluate the diagnostic accuracy of an index test to detect an IST confirmed by ultrasound in patients with LET. Methods A diagnostic retrospective study was performed. Patients who presented medical records with LET were recruited. Two orthopaedic surgeons developed the physical maneuver. The index test was considered positive when the position failed to resist the wrist extension maximum effort. Clinical findings were associated with confirmation of IST by US. Data were calculated using diagnostic accuracy, sensitivity, and specificity with 95% confidence intervals. Results Thirty-nine patients (39 elbows) were analyzed, 25 (64%) women and 14 (36%) men, with an average age of 47.7 years. The index test's sensitivity was 0.86 (95% CI, 0.67-0.96). Accuracy was 0.79 (95% CI, 0.64-0.91), and the specificity was 0.64 (95% CI, 0.31-0.89). Conclusion The index test presented very good sensitivity and good accuracy in patients with LET with US diagnostic confirmation of IST. Level of Evidence Diagnostic study, Level III.
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Affiliation(s)
- Cristóbal Greene
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile,Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Guillermo Droppelmann
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile,Health Sciences Ph.D. Program, Universidad Católica de Murcia, Murcia, Spain,Principles and Practice of Clinical Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Correspondence: Guillermo Droppelmann, Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile, Email
| | - Nicolás García
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, Chile
| | - Arturo Verdugo
- Centro de Medicina Ejercicio Deporte y Salud, Clínica MEDS, Santiago, Chile
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MRI and Ultrasound Analysis of Corticosteroid Injection Combined with Extracorporeal Shockwave Therapy in Lateral Epicondylitis—A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial. J Pers Med 2022; 12:jpm12111892. [DOI: 10.3390/jpm12111892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The knowledge about the effective implementation of corticosteroid injection and extracorporeal shockwave therapy on radiological changes in chronic lateral epicondylitis is lacking. Therefore, the objective of this study is to find and compare the effects of corticosteroid injection and extracorporeal shockwave therapy on radiological changes in chronic lateral epicondylitis. Methods: A randomized, double-blinded controlled study was conducted on 60 LE participants at a university hospital. The active extracorporeal shockwave therapy group (n = 30) received a corticosteroid injection with active extracorporeal shockwave therapy one session a week for 4 weeks, and the placebo extracorporeal shockwave therapy group received a corticosteroid injection with placebo extracorporeal shockwave therapy. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were the percentage of injury measured by magnetic resonance imaging and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status, and quality of life. Results: The between-group difference in pain intensity at 4 weeks was 1.4 (CI 95% 0.77 to 2.02), which shows more improvement in the active group than in the placebo group. Improvements in the effects were noted after 8 weeks and at 6 months (1.8; CI 95% 1.50 to 2.09) follow-up. Similar improvements were also found in the percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status, and quality of life. Conclusion: Extracorporeal shockwave therapy has added effects on corticosteroid injection for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with chronic lateral epicondylitis.
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Thomas JM, Chang EY, Ha AS, Bartolotta RJ, Bucknor MD, Caracciolo JT, Chen KC, Flug J, Kumaravel M, Raizman NM, Ross AB, Silvis ML, Surasi DS, Beaman FD. ACR Appropriateness Criteria® Chronic Elbow Pain. J Am Coll Radiol 2022; 19:S256-S265. [PMID: 36436956 DOI: 10.1016/j.jacr.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Chronic elbow pain can be osseous, soft tissue, cartilaginous, and nerve related in etiology. Imaging plays an important role in differentiating between these causes of chronic elbow pain. This document provides recommendations for imaging of chronic elbow pain in adult patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Jonelle M Thomas
- Vice-Chair of Clinical Affairs; Director, Radiology Informatics; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Roger J Bartolotta
- Division Chief, Musculoskeletal Imaging; Weill Cornell Medical College, New York, New York
| | - Matthew D Bucknor
- Associate Chair, Department of Radiology; University of California San Francisco, San Francisco, California
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; Section Head, MSK Imaging; MSK-RADS (Bone) Committee; Chairman, ACR MSK-RADS Committee
| | - Karen C Chen
- VA San Diego Healthcare System, San Diego, California; Musculoskeletal Radiology Section Chief Veterans Administration Healthcare System
| | - Jonathan Flug
- Mayo Clinic Arizona, Phoenix, Arizona; Chair, Radiology Quality Oversight Committee; Chair, Mayo Clinic Radiology Enterprise
| | - Manickam Kumaravel
- University of Texas Health Science Center (HSC), Houston, Texas; Committee on Emergency Radiology-General, Small, Emergency and/or Rural Practice; Assistant Vice President, University of Texas HSC, Houston, Texas
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, DC; American Academy of Orthopaedic Surgeons; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Matthew L Silvis
- Primary Care Physician; Director, Adult Ambulatory Care; Vice-Chair, Clinical Operations, Department of Family and Community Medicine; Division Chief, Primary Care Sports Medicine; Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Devaki Shilpa Surasi
- Commission on Nuclear Medicine and Molecular Imaging; Patient Safety and Quality Officer, Department of Nuclear Medicine, MD Anderson Cancer Center; Chair-Elect, Junior Faculty Committee, MD Anderson Cancer Center; The University of Texas MD Anderson Cancer Center, Houston, Texas
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Droppelmann G, Tello M, García N, Greene C, Jorquera C, Feijoo F. Lateral elbow tendinopathy and artificial intelligence: Binary and multilabel findings detection using machine learning algorithms. Front Med (Lausanne) 2022; 9:945698. [PMID: 36213676 PMCID: PMC9537568 DOI: 10.3389/fmed.2022.945698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ultrasound (US) is a valuable technique to detect degenerative findings and intrasubstance tears in lateral elbow tendinopathy (LET). Machine learning methods allow supporting this radiological diagnosis. Aim To assess multilabel classification models using machine learning models to detect degenerative findings and intrasubstance tears in US images with LET diagnosis. Materials and methods A retrospective study was performed. US images and medical records from patients with LET diagnosis from January 1st, 2017, to December 30th, 2018, were selected. Datasets were built for training and testing models. For image analysis, features extraction, texture characteristics, intensity distribution, pixel-pixel co-occurrence patterns, and scales granularity were implemented. Six different supervised learning models were implemented for binary and multilabel classification. All models were trained to classify four tendon findings (hypoechogenicity, neovascularity, enthesopathy, and intrasubstance tear). Accuracy indicators and their confidence intervals (CI) were obtained for all models following a K-fold-repeated-cross-validation method. To measure multilabel prediction, multilabel accuracy, sensitivity, specificity, and receiver operating characteristic (ROC) with 95% CI were used. Results A total of 30,007 US images (4,324 exams, 2,917 patients) were included in the analysis. The RF model presented the highest mean values in the area under the curve (AUC), sensitivity, and also specificity by each degenerative finding in the binary classification. The AUC and sensitivity showed the best performance in intrasubstance tear with 0.991 [95% CI, 099, 0.99], and 0.775 [95% CI, 0.77, 0.77], respectively. Instead, specificity showed upper values in hypoechogenicity with 0.821 [95% CI, 0.82, −0.82]. In the multilabel classifier, RF also presented the highest performance. The accuracy was 0.772 [95% CI, 0.771, 0.773], a great macro of 0.948 [95% CI, 0.94, 0.94], and a micro of 0.962 [95% CI, 0.96, 0.96] AUC scores were detected. Diagnostic accuracy, sensitivity, and specificity with 95% CI were calculated. Conclusion Machine learning algorithms based on US images with LET presented high diagnosis accuracy. Mainly the random forest model shows the best performance in binary and multilabel classifiers, particularly for intrasubstance tears.
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Affiliation(s)
- Guillermo Droppelmann
- Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, RM, Chile
- Health Sciences Ph.D. Program, Universidad Católica de Murcia UCAM, Murcia, Spain
- Principles and Practice of Clinical Research (PPCR), Harvard T.H. Chan School of Public Health, Boston, MA, United States
- *Correspondence: Guillermo Droppelmann,
| | - Manuel Tello
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Nicolás García
- MSK Diagnostic and Interventional Radiology Department, MEDS Clinic, Santiago, RM, Chile
| | - Cristóbal Greene
- Hand and Elbow Unit, Department of Orthopaedic Surgery, MEDS Clinic, Santiago, RM, Chile
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, RM, Chile
| | - Felipe Feijoo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy. BMC Musculoskelet Disord 2022; 23:803. [PMID: 35996100 PMCID: PMC9396854 DOI: 10.1186/s12891-022-05758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lateral epicondylitis is one of the most common upper extremity problems presented to orthopedic surgeons. Despite a rapid and accurate arrival at a diagnosis by clinical examination, there exists no consensus classification for this condition, which hampers clinical approaches for treatment of the disease based on its severity. Thus, the aim of this study was to propose and valiadate a new magnetic resonance imaging (MRI) classification of lateral epicondylitis, staging by tendinosis, the degree of thickness tears of the common extensor tendon (CET) and bone bruise lesion. METHOD MRI assessment of the elbow of 75 patients (57 women and 18 men; mean age:51.4 years (range,34-73) from Jan 2014 to Jan 2021 who were diagnosed with lateral epicondylitis were included in the study. MR images were reviewed retrospectively by two independent upper extremities orthopedists and one musculoskeletal radiologist. Inter- and intra-observer reliabilities for the classification were calculated using kappa statistics for the analysis of interrater agreement. Correlation between the stage of the disease and the duration of symptom before MRI was calculated using Kruskal-wallis test. RESULTS Various degrees of CET lesions were demonstrated in this population (Stage I-17, IIA-7, IIB-22 and III-29). Intra-observer agreements of MRI staging were substantial to satisfactory. Inter-observer agreements were moderate to substantial. There was no significant correlation between the disease stage and the patient age or the duration of symptom before MRI. CONCLUSION Our MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis. At the end, we have suggeted a clearer direction for understanding the disease pathology as well as an appropriate management protocol for each stage of the disease in line with the recent body of literature.
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Stegink-Jansen CW, Bynum JG, Lambropoulos AL, Patterson RM, Cowan AC. Lateral epicondylosis: A literature review to link pathology and tendon function to tissue-level treatment and ergonomic interventions. J Hand Ther 2021; 34:263-297. [PMID: 34167860 DOI: 10.1016/j.jht.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Common treatments for lateral epicondylosis (LE) focus on tissue healing. Ergonomic advice is suggested broadly, but recommendations based on biomechanical motion parameters associated with functional activities are rarely made. This review analyzes the role of body functions and activities in LE and integrates the findings to suggest motion parameters applicable to education and interventions relevant to activities and life roles for patients. PURPOSE This study examines LE pathology, tendon and muscle biomechanics, and population exposure outlining potentially hazardous activities and integrates those to provide motion parameters for ergonomic interventions to treat or prevent LE. A disease model is discussed to align treatment approaches to the stage of LE tendinopathy. STUDY DESIGN Integrative review METHODS: We conducted in-depth searches using PubMed, Medline, and government websites. All levels of evidence were included, and the framework for behavioral research from the National Institutes of Health was used to synthesize ergonomic research. RESULTS The review broadened the diagnosis of LE from a tendon ailment to one affecting the enthesis of the capitellum. It reinforced the continuum of severity to encompass degeneration as well as regeneration. Systematic reviews confirmed the availability of evidence for tissue-based treatments, but evidence of well-defined harm reducing occupational interventions was scattered amongst evidence levels. Integration of biomechanical studies and population information gave insight into types of potentially hazardous activities and provided a theoretical basis for limiting hazardous exposures to wrist extensor tendons by reducing force, compression, and shearing during functional activities. CONCLUSIONS These findings may broaden the first treatment approach from a passive, watchful waiting into an active exploration and reduction of at-risk activities and motions. Including the findings into education modules may provide patients with the knowledge to lastingly reduce potentially hazardous motions during their daily activities, and researchers to define parameters of ergonomic interventions.
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Affiliation(s)
- Caroline W Stegink-Jansen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Julia G Bynum
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Alexandra L Lambropoulos
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rita M Patterson
- Department of Family and Osteopathic Manipulative Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - April C Cowan
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
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Daniels SP, De Tolla JE, Azad A, Fritz J. Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles. Semin Musculoskelet Radiol 2021; 25:589-599. [PMID: 34706389 DOI: 10.1055/s-0041-1731790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jadie E De Tolla
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Ali Azad
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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13
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Leschinger T, Tischer T, Doepfer AK, Glanzmann M, Hackl M, Lehmann L, Müller L, Reuter S, Siebenlist S, Theermann R, Wörtler K, Banerjee M. Epicondylopathia humeri radialis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:329-340. [PMID: 33851405 DOI: 10.1055/a-1340-0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options - with varying levels of evidence. METHOD The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 - 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process. OUTCOMES Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure. CONCLUSION This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.
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Affiliation(s)
- Tim Leschinger
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Thomas Tischer
- Rostock University Medical Centre, Department of Orthopaedics, Rostock, Germany
| | | | | | - Michael Hackl
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Lars Lehmann
- Department of Trauma and Hand Surgery, ViDia Christliche Kliniken Karlsruhe, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Lars Müller
- Division of Trauma, Hand and Elbow Surgery, Cologne University Medical Centre, Cologne, Germany
| | - Sven Reuter
- SRH Hochschule für Gesundheit, Campus Stuttgart, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralf Theermann
- Joint Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
| | - Klaus Wörtler
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marc Banerjee
- Mediapark Klinik, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany
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14
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Shannon N, Cable B, Wood T, Kelly J. Common and Less Well-known Upper-limb Injuries in Elite Tennis Players. Curr Sports Med Rep 2021; 19:414-421. [PMID: 33031207 DOI: 10.1249/jsr.0000000000000760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.
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Affiliation(s)
| | - Brian Cable
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Timothy Wood
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - John Kelly
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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15
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Heales LJ, Randall S, Vicenzino B, Coombes BK, Obst S. An evidence-based evaluation of mobile health apps for the management of individuals with lateral elbow tendinopathy using a systematic review framework. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1885584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Luke J. Heales
- School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Samantha Randall
- School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitations Sciences, The University of Queensland, Brisbane, Australia
| | - Brooke K. Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Steven Obst
- School of Health, Medical, and Applied Sciences, Central Queensland University, Bundaberg, Australia
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16
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Curti S, Mattioli S, Bonfiglioli R, Farioli A, Violante FS. Elbow tendinopathy and occupational biomechanical overload: A systematic review with best-evidence synthesis. J Occup Health 2021; 63:e12186. [PMID: 33534951 PMCID: PMC7857538 DOI: 10.1002/1348-9585.12186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the evidence of an association between occupational and non-occupational exposure to biomechanical risk factors and lateral elbow tendinopathy, medial elbow tendinopathy, and olecranon bursitis. METHODS We carried out a systematic review of the literature. We searched MEDLINE (up to November 2019) and checked the reference lists of relevant articles/reviews. We aimed to include studies where (a) the diagnosis was based on physical examination (symptoms plus clinical signs) and imaging data (if any); and (b) the exposure was evaluated with video analysis and/or direct measurements. A quality assessment of the included studies was performed along with an evaluation of the level of evidence of a causal relationship. RESULTS We included four studies in the qualitative synthesis: two prospective cohorts and two cross-sectional studies. All the included studies investigated "lateral/medial epicondylitis", albeit the diagnosis was not supported by imaging techniques. Two cohort studies suggested that a combination of biomechanical risk factors for wrist/forearm is associated with increased risk of "lateral epicondylitis". This association was not observed in the two included cross-sectional studies. The cohort studies suggested that a Strain Index score higher than 5 or 6.1 could double the risk of "lateral epicondylitis". No association with increased risk of "medial epicondylitis" was observed. CONCLUSIONS There is limited evidence of a causal relationship between occupational exposure to biomechanical risk factors and lateral elbow tendinopathy. For medial elbow tendinopathy, the evidence is insufficient to support this causal relationship. No studies on olecranon bursitis and biomechanical overload were identified.
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Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Francesco S. Violante
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
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Arrigoni P, Cucchi D, Luceri F, Zagarella A, Catapano M, Menon A, Bruno V, Gallazzi M, Randelli PS. Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:4067-4074. [PMID: 34455451 PMCID: PMC8595151 DOI: 10.1007/s00167-021-06711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. METHODS Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. RESULTS The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. CONCLUSIONS Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity.
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Affiliation(s)
- Paolo Arrigoni
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Francesco Luceri
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Andrea Zagarella
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Michele Catapano
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Valentina Bruno
- Istituto Clinico San Siro, Via Monreale, 18, 20148 Milan, Italy
| | - Mauro Gallazzi
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,Department of Biomedical Sciences for Health, Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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18
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Dixit A, Dandu N, Hadley CJ, Nazarian LN, Cohen SB, Ciccotti M. Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Elbow Sports Injuries. JBJS Rev 2020; 8:e19.00219. [PMID: 33186208 DOI: 10.2106/jbjs.rvw.19.00219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Ultrasonography is a valuable diagnostic imaging tool because of its availability, tolerability, low cost, and utility in real-time dynamic evaluation. Its use in diagnosing elbow injuries has expanded recently and continues to do so. In particular, stress ultrasonography represents a unique imaging technique that directly visualizes the ulnar collateral ligament (UCL) and allows the assessment of ligament laxity, offering an advantage over magnetic resonance imaging and magnetic resonance arthrography in this patient population. Furthermore, ultrasonography has shown particular usefulness in instances where invasive techniques might be less desirable. This is particularly important in athletes since more invasive procedures potentially result in lost time from their sport. Ultrasonography is an important imaging tool that complements a thorough history and physical examination in the evaluation of elbow injuries in athletes. The use of ultrasonography in orthopaedic sports medicine has been investigated previously; however, to our knowledge, there has been no comprehensive review regarding the utility of ultrasonography for common elbow injuries in athletes. The current study provides a comprehensive, detailed review of the utility and indications for the use of ultrasonography for common elbow injuries in athletes.
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Affiliation(s)
- Anant Dixit
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Pasadena, California
| | - Navya Dandu
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Christopher J Hadley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Levon N Nazarian
- Thomas Jefferson University Hospital at Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Steven B Cohen
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Ciccotti
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Mills FB, Williams K, Chu CH, Bornemann P, Jackson JB. Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons. Foot Ankle Int 2020; 41:1049-1055. [PMID: 32567358 DOI: 10.1177/1071100720931085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs. METHODS Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy. RESULTS Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants. CONCLUSION Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- F Baker Mills
- Palmetto Health-USC Orthopaedic Center, Columbia, SC, USA
| | - Kevin Williams
- Palmetto Health-USC Orthopaedic Center, Columbia, SC, USA
| | | | - Paul Bornemann
- Palmetto Health-USC Family Medicine Center, Columbia, SC, USA
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Zhu B, You Y, Xiang X, Wang L, Qiu L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg 2020; 10:211-219. [PMID: 31956543 DOI: 10.21037/qims.2019.10.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To investigate the role of shear wave elastography (SWE) in patients with lateral epicondylitis (LE) by assessing the common extensor tendon (CET) elasticity. Methods A total of 62 unilateral LE patients were enrolled. Shear wave speed (SWS) and the thickness of CET in both elbows, along with the involved elbows with pre- and post-treatment, were obtained by SWE. The differences between groups, inter- and intra-observer agreements, and diagnostic accuracy were analyzed with a paired t-test, intraclass correlation coefficients (ICCs), and receiver operator characteristic (ROC) curve, respectively. Results LE patients had significantly lower SWS on lesion sides compared to healthy elbows (P<0.05). The SWS of involved elbows were significantly higher after non-operation treatment than before treatment. The inter- and intra-observer agreements were excellent (ICCs: 0.900-0.993) for SWE measurements. Moreover, a 12.2 m/s cutoff value of mean SWS (C mean) for discriminating LE patients from healthy subjects revealed a sensitivity and specificity of 93% and 93%, respectively. Conclusions SWE is a valid imaging technique for the diagnosis of LE and monitoring of the treatment effect. Future studies are essential for investigating the correlations among clinical examinations, conventional ultrasound, and SWE.
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Affiliation(s)
- Bihui Zhu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yingqi You
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liyun Wang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
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