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Common Extensor Tendon Injury, Elbow
Donna G. Blankenbaker, MD; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Extensor tendinopathy (preferred term), extensor tendinosis extensor tendinitis, lateral epicondylitis, tennis elbow
            • Definitions

              • Acute or chronic injury to origin of common extensor tendon at its attachment to lateral humeral epicondyle
              • Almost always related to chronic repetitive microtrauma leading to macroscopic tear
              • Lateral epicondylitis is thus doubly inaccurate
                • Does not involve epicondyle except with reactive edema (pathology is primarily in tendon)
                • Not itis because it is only inflammatory at earliest stages
              • Common extensor tendons
                • Conjoined tendon
                  • Extensor carpi radialis brevis
                  • Extensor digitorum communis
                  • Extensor carpi ulnaris
                • Extensor digiti minimi
                • Extensor carpi radialis longus, brachioradialis, and supinator remainder of extensor mechanism

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Dines JS et al: Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 23(3):181-189, 2015
                                              2. Konin GP et al: US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics. 33(4):E125-47, 2013
                                              3. Tosti R et al: Lateral epicondylitis of the elbow. Am J Med. 126(4):357.e1-6, 2013
                                              4. Wenzke DR: MR imaging of the elbow in the injured athlete. Radiol Clin North Am. 51(2):195-213, 2013
                                              5. Kotnis NA et al: Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol. 41(4):369-86, 2012
                                              6. Poltawski L et al: Reliability of sonographic assessment of tendinopathy in tennis elbow. Skeletal Radiol. 41(1):83-9, 2012
                                              7. Lee MH et al: Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. AJR Am J Roentgenol. 196(6):1363-7, 2011
                                              8. Clarke AW et al: Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. Am J Sports Med. 38(6):1209-14, 2010
                                              9. Frick MA et al: Imaging of the elbow: muscle and tendon injuries. Semin Musculoskelet Radiol. 14(4):430-7, 2010
                                              10. Cohen MS et al: Open and arthroscopic management of lateral epicondylitis in the athlete. Hand Clin. 25(3):331-8, 2009
                                              11. De Zordo T et al: Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol. 193(1):180-5, 2009
                                              12. Housner JA et al: Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 28(9):1187-92, 2009
                                              13. Merrell G et al: Arthroscopic treatment of lateral epicondylitis. J Hand Surg Am. 34(6):1130-4, 2009
                                              14. Scher DL et al: Lateral epicondylitis. Orthopedics. 32(4), 2009
                                              15. Sampson S et al: Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 1(3-4):165-74, 2008
                                              16. Thornton SJ et al: Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med. 33(10):1558-64, 2005
                                              17. Chung CB et al: MR imaging of tendon abnormalities of the elbow. Magn Reson Imaging Clin N Am. 12(2):233-45, vi, 2004
                                              18. Miller TT et al: Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 30(4):193-202, 2002
                                              19. Bredella MA et al: MR imaging findings of lateral ulnar collateral ligament abnormalities in patients with lateral epicondylitis. AJR Am J Roentgenol. 173(5):1379-82, 1999
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Extensor tendinopathy (preferred term), extensor tendinosis extensor tendinitis, lateral epicondylitis, tennis elbow
                                                        • Definitions

                                                          • Acute or chronic injury to origin of common extensor tendon at its attachment to lateral humeral epicondyle
                                                          • Almost always related to chronic repetitive microtrauma leading to macroscopic tear
                                                          • Lateral epicondylitis is thus doubly inaccurate
                                                            • Does not involve epicondyle except with reactive edema (pathology is primarily in tendon)
                                                            • Not itis because it is only inflammatory at earliest stages
                                                          • Common extensor tendons
                                                            • Conjoined tendon
                                                              • Extensor carpi radialis brevis
                                                              • Extensor digitorum communis
                                                              • Extensor carpi ulnaris
                                                            • Extensor digiti minimi
                                                            • Extensor carpi radialis longus, brachioradialis, and supinator remainder of extensor mechanism

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Dines JS et al: Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 23(3):181-189, 2015
                                                                                          2. Konin GP et al: US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics. 33(4):E125-47, 2013
                                                                                          3. Tosti R et al: Lateral epicondylitis of the elbow. Am J Med. 126(4):357.e1-6, 2013
                                                                                          4. Wenzke DR: MR imaging of the elbow in the injured athlete. Radiol Clin North Am. 51(2):195-213, 2013
                                                                                          5. Kotnis NA et al: Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol. 41(4):369-86, 2012
                                                                                          6. Poltawski L et al: Reliability of sonographic assessment of tendinopathy in tennis elbow. Skeletal Radiol. 41(1):83-9, 2012
                                                                                          7. Lee MH et al: Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. AJR Am J Roentgenol. 196(6):1363-7, 2011
                                                                                          8. Clarke AW et al: Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. Am J Sports Med. 38(6):1209-14, 2010
                                                                                          9. Frick MA et al: Imaging of the elbow: muscle and tendon injuries. Semin Musculoskelet Radiol. 14(4):430-7, 2010
                                                                                          10. Cohen MS et al: Open and arthroscopic management of lateral epicondylitis in the athlete. Hand Clin. 25(3):331-8, 2009
                                                                                          11. De Zordo T et al: Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol. 193(1):180-5, 2009
                                                                                          12. Housner JA et al: Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 28(9):1187-92, 2009
                                                                                          13. Merrell G et al: Arthroscopic treatment of lateral epicondylitis. J Hand Surg Am. 34(6):1130-4, 2009
                                                                                          14. Scher DL et al: Lateral epicondylitis. Orthopedics. 32(4), 2009
                                                                                          15. Sampson S et al: Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 1(3-4):165-74, 2008
                                                                                          16. Thornton SJ et al: Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med. 33(10):1558-64, 2005
                                                                                          17. Chung CB et al: MR imaging of tendon abnormalities of the elbow. Magn Reson Imaging Clin N Am. 12(2):233-45, vi, 2004
                                                                                          18. Miller TT et al: Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 30(4):193-202, 2002
                                                                                          19. Bredella MA et al: MR imaging findings of lateral ulnar collateral ligament abnormalities in patients with lateral epicondylitis. AJR Am J Roentgenol. 173(5):1379-82, 1999