DIAGNOSING TENNIS ELBOW WITH ULTRASOUND

Tennis elbow is also called lateral epicondylitis. Repetitive motion of the forearm muscles, which attach to the outside of your elbow, can cause swelling or tearing of the tendons that bend your wrist backward.

Symptoms of lateral epicondylitis can include pain, burning, or an ache along the outside of the forearm and elbow. As it gets worse, pain may spread down to the wrist and your grip may become weak.

To investigate the source and cause for your symptoms, your doctor will likely order medical imaging:

• A musculoskeletal (MSK) ultrasound is a specialized exam that uses high frequency sound waves transmitted through a handheld device to look at your muscles and joints.
• X-ray imaging uses a small amount of radiation, passing it through a body part, to see your bones and the spaces between them.
• Magnetic resonance imaging (MRI) uses a strong magnetic field and radiofrequency waves to examine the soft tissues of the body along with the bones.

For joint symptoms, an MSK ultrasound is frequently ordered with an X-ray to allow the radiologist to have a more complete evaluation of the joint and surrounding bones. One looks at the soft tissues of your body and the other looks at bone, so they are often used together to diagnose a problem especially in the joints. MRI is most often ordered when more detail is needed based on the results of ultrasound or X-ray exams, or other imaging studies.

WHAT ARE THE BENEFITS OF AN MSK ULTRASOUND?

An MSK ultrasound may help determine the source of your muscle or joint symptoms. For example, if lateral epicondylitis is suspected, it can be used to investigate if your tendons are inflamed or damaged. Ultrasound can help determine the extent of the injury, sometimes clarify if surgery is indicated, and assess how well these injuries are healing.

Ultrasound can allow you, as the patient, to show us exactly where you feel your symptoms, so we can pinpoint your area of concern at the time of imaging. Plus, ultrasound doesn’t use radiation, so it can be safely performed on all patients including pregnant women and babies. Compared to other types of imaging, it is also very portable.

WHAT ARE THE TREATMENT OPTIONS?

If imaging confirms lateral epicondylitis, your doctor will likely tell you to rest your elbow and stop the activity that is causing the symptoms. They may also suggest:

• Anti-inflammatory medicines (such as ibuprofen).
• Ice packs to reduce inflammation.
• Strengthening and stretching exercises.

If these initial treatments are not effective, your doctor may consider additional treatments, such as:

• Bracing
• Cortisone (steroid) injection – this procedure allows a small dose of anti-inflammatory medication to be injected into a localized and specific area of concern under image guidance to decrease inflammation and pain. Relief may last 3-6 months and, if successful, repeat injections can be performed up to four times per year.
• Platelet-rich plasma (PRP) injection – this treatment is used to speed the healing of new injuries, as well as repair chronic injuries. Platelet-rich plasma is taken from your own blood and injected with a needling technique under ultrasound guidance to stimulate your body to heal itself. It can be combined with tenotomy (fenestration) therapy.
• Tenotomy (fenestration) therapy – this procedure involves needle fenestration of a tendon, similar to acupuncture, which encourages your body to stimulate healing. A radiologist will use a small needle to gently treat the torn or inflamed area with the help of image-guided technology. This procedure is used to treat chronic tendon inflammation or tears.

HOW DO I GET IMAGING?

Your personal medical history will help determine which type of imaging is best suited to diagnose your concern. In determining appropriateness, there are a number of questions you could discuss with your doctor. What are your treatment options? What outcomes could be expected for each option? How do the different types of imaging work? What are the risks? What happens if you don’t have imaging? What happens after your exam?

Once your doctor has identified the need for an exam, you will be given a requisition form. For ultrasound exams, your doctor may book your exam for you, or you may be given the number for our Contact Centre to book an appointment. Ultrasound exams are covered under your provincial health care plan.

Our pain management exams are only offered in Alberta. Pain management procedures must be requested by a health care practitioner. Once the cause has been identified and treatment options reviewed, a pain management procedure may be recommended by us or requested by your practitioner. You will need a requisition from your physician. Once we have received the requisition, we will then review it and contact you to confirm the area and type of injection requested, and to book the appointment. Cortisone injections and tendon fenestration therapy are covered under your Alberta health care plan.

For MRI exams, your doctor will send us your requisition (for both public or private exams) and we will call you to schedule your exam and provide you with detailed information to prepare for it.

In Alberta, we offer MRI services as private pay exams, for when patients may be unable to wait to receive an exam through the public health system. An MRI’s magnetic field strength is measured in teslas (T) and Mayfair operates both 1.5T and 3T MRI services at our Mayfair Place location in Calgary. The highly sensitive images from the 3T machine allows enhanced imaging of many areas of the body, including musculoskeletal imaging of joints and soft tissues.

In Saskatchewan, we offer MRIs as a publicly funded, community-based service under contract with the Saskatchewan Health Authority and as a private pay exam. Private MRI services in Saskatchewan are provided in accordance with and under the legislation of the Province of Saskatchewan.

Once your exam is completed, your images will be reviewed by a specialized radiologist who will compile a report that is sent to your doctor. Mayfair Diagnostics is owned and operated by over 50 radiologists who are sub-specialty trained, which guarantees an expert opinion of your imaging.

Mayfair Diagnostics has 13 locations across Calgary which provide ultrasound services, as well as one in Cochrane and one in Regina. Mayfair Diagnostics offers MRI imaging as a private pay service at our Mayfair Place location in Calgary, and as both public and private pay exams at our Regina and Saskatoon locations in Saskatchewan.

For more information, please visit our services page or call our toll-free number 1-866-611-2665.

REFERENCES

Gonzales, S., MD (2019) “9 Amazing Facts about Ultrasound Imaging.” www.p2sportscare.com. Accessed January 24, 2024.

Mayo Clinic Staff (2023) “Tennis elbow.” www.mayoclinic.org. Accessed January 24, 2024.

John Hopkins Medicine (2023) “Lateral Epicondylitis (Tennis Elbow).” www.hopkinsmedicine.org. Accessed January 24, 2024.

Radiological Society of North America (2023) “Musculoskeletal Ultrasound.” www.radiologyinfo.org. Accessed January 24, 2024.

Wang, Q. et al. (2017) “Quantitative Analysis of Musculoskeletal Ultrasound: Techniques and Clinical Applications.” Biomed Research International. Accessed January 24, 2024.