Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedic surgery. Amsterdam University Medical Centers, Amsterdam, the Netherlands. Amphia Hospital, Breda, the Netherlands.

2 Foundation for Orthopedic Research, Care & Education, Amphia Hospital

3 Department of Radiology, Amphia Hospital, Breda, the Netherlands

4 Department of Orthopedic Surgery, Amphia Hospital Breda, the Netherlands. Coronel Institute of Occupational health, Amsterdam University Medical Centers, the Netherlands.

5 Department of Orthopedic Surgery, Amhpia Hospital, Breda, the Netherlands

6 Department of Orthopedic Surgery, Amhpia Hospital, Breda, the Netherlands Department of Orthopedic Surgery, AMC, Amsterdam, the Netherlands

Abstract

Introduction
Lateral epicondylitis (LE) most commonly affects the Extensor Carpi Radialis Brevis (ECRB) tendon and patients are generally treated with injection therapy. For optimal positioning of the injection, as well as an estimation of the surface area and content of the ECRB tendon to determine the volume of the injectable needed, it is important to know the exact location of the ECRB in relation to the skin as well as the variation in tendon length and location. The aim of this study was to determine the variation in location and size of the ECRB tendon in patients with LE.

Methods
An observational sonographic evaluation of the ECRB tendon was performed in 40 patients with LE. The length of the ECRB tendon, distance from the cutis to the center of the ECRB tendon, the length of the osteotendinous junction at the epicondyle and the distance from cutis to middle of the osteotendinous junction were measured.

Results
The average tendon length was 1.68cm (range 1.27-1.98; SD 0.177). Compared to women, the ECRB tendon of men was on average 0.12cm longer. Overall, the average distance from cutis to the center of the ECRB was 0.75cm (range 0.50-1.46cm; SD 0.210), the average length of the junction was 0.55cm (range 0.35-0.87; SD 0.130), and the distance from cutis to middle of the osteotendinous junction was 0.73cm (range 0.40-1.25cm; SD 0.210).

Conclusion
The size and depth of the ECRB tendon in patients with LE is largely variable. While there are no studies yet suggesting sono-guided injection to be superior to that of blind injection, the anatomic variability of this study suggests that the accuracy of injection therapy for LE might be compromised when based solely on bony landmarks and therefore not fully reliable.

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