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The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review

BACKGROUND: Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on t...

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Autores principales: Dones, Valentin C, Grimmer, Karen, Thoirs, Kerry, Suarez, Consuelo G, Luker, Julie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015882/
https://www.ncbi.nlm.nih.gov/pubmed/24589069
http://dx.doi.org/10.1186/1471-2342-14-10
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author Dones, Valentin C
Grimmer, Karen
Thoirs, Kerry
Suarez, Consuelo G
Luker, Julie
author_facet Dones, Valentin C
Grimmer, Karen
Thoirs, Kerry
Suarez, Consuelo G
Luker, Julie
author_sort Dones, Valentin C
collection PubMed
description BACKGROUND: Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. METHODS: Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). RESULTS: Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. CONCLUSIONS: The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient’s condition.
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spelling pubmed-40158822014-05-10 The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review Dones, Valentin C Grimmer, Karen Thoirs, Kerry Suarez, Consuelo G Luker, Julie BMC Med Imaging Research Article BACKGROUND: Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. METHODS: Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). RESULTS: Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. CONCLUSIONS: The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient’s condition. BioMed Central 2014-03-03 /pmc/articles/PMC4015882/ /pubmed/24589069 http://dx.doi.org/10.1186/1471-2342-14-10 Text en Copyright © 2014 Dones et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Research Article
Dones, Valentin C
Grimmer, Karen
Thoirs, Kerry
Suarez, Consuelo G
Luker, Julie
The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
title The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
title_full The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
title_fullStr The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
title_full_unstemmed The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
title_short The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
title_sort diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015882/
https://www.ncbi.nlm.nih.gov/pubmed/24589069
http://dx.doi.org/10.1186/1471-2342-14-10
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