Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation

Andrea S. Klauser, Mathias Pamminger, Ethan J. Halpern, Mohamed M.H. Abd Ellah, Bernhard Moriggl, Mihra S. Taljanovic, Christian Deml, Judit Sztankay, Guenther Klima, Werner R. Jaschke

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Purpose: To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation. Materials and methods: Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies. Results: Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%). Conclusion: Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology. Key Points: • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis. • Combination of B-mode US and SEL in lateral epicondylitis correlates to histology. • Combination of both modalities provides improved sensitivity without loss of specificity.

Original languageEnglish (US)
Pages (from-to)3460-3466
Number of pages7
JournalEuropean Radiology
Issue number8
StatePublished - Aug 1 2017


  • Epicondylitis
  • Histology
  • Sonoelastography
  • Tendinosis
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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