Diagnostic Utility of High-Resolution Ultrasonography in Clinically Suspected Lateral Epicondylitis: A Prospective Observational Study

Abstract

Background: Lateral epicondylitis is a common cause of lateral elbow pain, and its diagnosis is primarily based on clinical examination. High-resolution ultrasonography (HRUS) provides objective assessment of tendon morphology and vascularity and may improve diagnostic accuracy. This study evaluated the diagnostic utility of HRUS in clinically suspected lateral epicondylitis.Materials and Methods: This prospective observational study included 70 consecutive patients with clinically suspected lateral epicondylitis. Both symptomatic and contralateral asymptomatic elbows (140 elbows) were examined using gray-scale, colour Doppler, and power Doppler ultrasonography. Tendon thickness, echogenicity, fibrillar pattern, tears, calcifications, cortical irregularity, peritendinous fluid, ligament abnormalities, and neovascularization were assessed. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.Results: Gray-scale ultrasonography demonstrated significantly higher frequencies of tendon thickening, abnormal echogenicity, loss of fibrillar pattern, tendon tears, calcifications, cortical irregularity, and peritendinous fluid in symptomatic elbows than in contralateral controls (all p<0.001, except tendon tears, p=0.002, and lateral collateral ligament tears, p=0.004). Neovascularization was detected in 51.4% of symptomatic elbows (p<0.001). Combined gray-scale and colour Doppler ultrasonography showed the highest diagnostic performance with a sensitivity of 80.43%, specificity of 75.00%, PPV of 86.05%, NPV of 66.67%, and overall accuracy of 78.57%.Conclusion: High-resolution ultrasonography is a reliable, non-invasive imaging modality for evaluating clinically suspected lateral epicondylitis. Gray-scale ultrasonography effectively detects structural tendon abnormalities, while Doppler imaging provides complementary information on vascularity. Combined assessment improves diagnostic performance and supports accurate diagnosis, disease grading, and treatment planning