A single simple position for ultrasound assessment of both common extensor and common flexor origin at the elbow

Abstract Objective: Is to evaluate the simplicity of 90° flexion/neutral position for ultrasonography assessment of both common extensor and common flexor origins in comparison with the standard position. Material and methods: A standard questionnaire was distributed on 50 trainees, rheumatologists with No previous experience or training in ultrasonography. (They) were attending musculoskeletal training workshops at AL-Azhar rheumatology department musculoskeletal ultrasonography unit in 2016. Each participant then (was) asked to practice US examination of both common extensor and common flexor origins in both positions and then fill four questionnaires, two (of which are) for common flexor and (the other) two (are) for the common extensor origins, in the standard and the other proposed single position. Each questionnaire (whose) answer was graded on scale from 0 to 10, includes the following points: Time needed to examine the tendon in minutes, Difficulty in maintaining the probe contact to the skin, Difficulty in getting good image of the tendon, The overall impression of simplicity. Results: Descriptive analysis of the questionnaire results shows that the participants favors the single position in all questionnaire parameters. Comparing means of the four questionnaire parameters in both positions shows highly significant difference in the four parameters at the level of both common flexor and extensor origins in favor of the single position as p > 0.005. Conclusion: The 90 degree flexion/neutral position appears to be simpler than the standard position for ultrasonography assessment of common extensor and common flexor tendons at the elbow.

Calcific Tendinitis of the Common Extensor Tendon: A Case Report / 대한스포츠의학회지

Calcific tendinitis is most common seen within the rotator cuff of the shoulder, although it may develop around the hip, wrist, elbow, knee, forefoot, and neck. However, there has been no report in the medical literature regarding calcific tendinitis of the common extensor tendon. We present a case of a 26-year-old woman who had calcific tendinitis of the common extensor tendon. Intraoperatively, partial rupture and calcific deposit at the insertion of the common extensor tendon were seen. We were removed calcific deposit and ruptured tissue of common extensor tendon, and then ruptured common extensor tendon was sutured. The patient showed excellent result two years postoperatively with return to range in a degree of activity levels.

Incomplete Compressive Neuropathy of Posterior Interosseous Nerve Caused by Ganglion : A Case Report

Ganglion is a common benign tumor and is likely to cause paralysis of posterior interosseous nerve by compressiononce occurred in proximal radial area. A 25- year old female patient, who was suffering from forearm pain and trouble with extending her fingers after intramuscular stimulation, visited this hospital. We diagnosed as the common extensor muscle rupture by physical examination. But, on the basis of preoperative MRI, she was diagnosed with incomplete posterior interosseous nerve paralysis caused by ganglion of the proximal radius. We performed the surgical excision and obtained a satisfactory result without any evidence of recurrence at the 1 year follow-up after surgery. Incomplete compressive neuropathy of posterior interosseous nerve sometimes confused with spontaneous rupture of the common extensor muscle, which can lead to inappropriate surgical treatment. Careful preoperative examination is essential to avoid misdiagnosis. We report this case with review of the relevant literature, because of rarity of incomplete compressive neuropathy of posterior interosseous nerve by ganglion.

Ultrasonographic Findings of Chronic Lateral Epicondylitis with Partial Tear before and after Prolotherapy

OBJECTIVE: To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. METHOD: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. RESULTS: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. CONCLUSION: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis.