The US findings of tendon thickening, neovascularisation and tendon elasticity changes have high sensitivities and specificities for LET, and can prove useful in the overall diagnostic context of LET.
Abstract
Introduction: Lateral Epicondyle Tendinopathy (LET), or 'Tennis Elbow', is a common
musculoskeletal condition affecting athletes and individuals engaging in repetitive movements of
the common extensor tendon (CET). Ultrasonography (US) is a popular, cost-effective and
non-invasive imaging modality to assess the elbow for LET. Several characteristic US findings
have been reported, but there is no established consensus for which are best diagnostic for LET.
We systematically reviewed the published literature for the diagnostic accuracy (sensitivity and
specificity) of US for LET.
Methods: The PubMed database was searched systematically to identify relevant articles
published from inception to 29th June 2026. The inclusion criteria involved studies investigating the
diagnostic accuracy of US findings in LET against a reference standard, e.g. clinical examination
or magnetic resonance imaging (MRI). Excluded studies were those lacking diagnostic outcome
data or those combining imaging modalities in calculating diagnostic accuracy. Sensitivities and
specificities were extracted from the studies.
Results: In total, 147 records were identified and 11 studies were included in this review following
screening (Figure 1). Tendon thickening of ≥ 4.85 mm demonstrated the highest sensitivity
(90.5%), whilst ≥ 4.2 mm was the most specific (95.2%). Neovascularisation assessment via colour
Doppler demonstrated superior sensitivities (57–95%) and specificities (88–100%) when
compared to power Doppler. When assessing tendon elasticity, shear-wave elastosonography
(SWE) and grey-scale US displayed superior sensitivities (90.5–100% and 95% respectively)
compared to compression sonoelastography (SEL). However, all three US techniques confirmed
elasticity changes are highly specific for LET.
Conclusion: The US findings of tendon thickening, neovascularisation and tendon elasticity
changes have high sensitivities and specificities for LET. Other signs, such as cortical irregularities
and tendon tears, varied in their diagnostic accuracies. However, these characteristic US findings,
alongside a patient history and clinical examination, can prove useful in the overall diagnostic
context of LET.
Lumbosacral radiculopathy, commonly caused by disc protrusion or joint hypertrophy, can also stem from lumbar epidural varix (LEV), a rare condition involving vertebral venous plexus dilation. This systematic review evaluates the diagnostic approaches used to identify LEVs in patients presenting with radiculopathy, with particular emphasis on imaging modalities and clinical diagnostic strategies.
Using the PICO framework, studies from January 2014 to June 2024 were systematically reviewed. MEDLINE, CINAHL, PubMed, and Embase were searched for peer-reviewed articles in English. Included studies examined diagnostic methods used to identify LEVs, including imaging modalities such as magnetic resonance imaging (MRI), CT myelography, and venospondylography, as well as clinical findings reported in affected patients. Data synthesis focused on diagnostic accuracy parameters and treatment outcomes following surgical interventions.
Seven studies met the inclusion criteria, involving 109 patients with LEV-related radiculopathy. MRI demonstrated high sensitivity (87%–100%) and specificity (80%–95%) in identifying varices and associated neural compression. Surgical interventions, including laminectomy and microsurgical techniques, consistently led to symptom resolution and minimal recurrence rates.
This review underscores MRI’s efficacy in diagnosing LEV and guiding effective surgical management, despite diagnostic challenges. Early and accurate diagnosis through comprehensive clinical and imaging evaluations is crucial for optimizing therapeutic strategies and improving patient outcomes in LEV-related radiculopathy.
Kayode Agboola, Bipin Chaurasia, Eugene I. Slin'ko· International Journal of Sur...· 0 citations
Background
Lateral elbow tendinopathy (LET) is the most common musculoskeletal elbow disorder. Evidence suggests that cervicothoracic involvement often contributes to forearm symptoms and that addressing the spine improves clinical outcomes. This review aimed to evaluate screening methods for the cervicothoracic spine in randomized controlled trials (RCTs) that evaluated and treated LET.
Methods
This review included RCTs from PubMed, CINAHL, and CENTRAL (inception to 10 June 2025) that evaluated conservative interventions for adults with a primary diagnosis of LET. Data on cervicothoracic spine screening methods were categorized into three levels: thorough (≥4 screening items), partial (1-3 items), or no screening. Frequencies reported the extent of screening across trials.
Results
A total of 2744 articles were retrieved, and 208 RCTs were included for data extraction. Four (1.9%) RCTs adequately reported a thorough cervicothoracic screening process before diagnosing LET, based on predefined screening criteria. A total of six trials (2.9%) were partially screened, while many (95.2%) reported no screening.
Discussion
Less than 2% of LET RCTs did not perform or explicitly report objective screening of the cervicothoracic region, highlighting a need for standardized screening protocols to better characterize participants in future research and clarify the role of the cervicothoracic spine in LET outcomes.
Matthew R. Schumacher, Emma K. Bakken, Kaitlyn P. Reynolds et al.· Shoulder & Elbow· 0 citations
Background: Deep gluteal syndrome (DGS) is an increasingly recognized cause of posterior hip pain, particularly in athletes and physically act give individuals. It results from entrapment of neural structures within the deep gluteal space, frequently associated with musculotendinous imbalance, repetitive hip movements, and sport-specific biomechanical stress. Purpose: To systematically describe the musculotendinous and neural entrapment mechanisms underlying DGS, with particular focus on clinical presentation, imaging findings, and management strategies in athletes. Furthermore, a secondary aim was to evaluate the frequency and clinical relevance of DGS-related conditions reported in athletes. Methods: A systematic descriptive review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, PEDro, and the Cochrane Library were searched. Studies addressing anatomical predispositions, clinical features, imaging characteristics, and conservative or surgical treatment were included. Results: Eighty-four studies met the inclusion criteria. DGS encompasses multiple entrapment patterns involving the sciatic, pudendal, posterior femoral cutaneous and superior gluteal nerves. In athletes, repetitive hip flexion–adduction–internal rotation movements, overuse microtrauma and hypertrophic musculature appear to contribute to neural compression. Clinical diagnosis remains challenging due to symptom overlap with lumbar disorders. MRI represents the primary imaging modality, although findings may be subtle or nonspecific. Initial management is conservative, while endoscopic decompression may be indicated in refractory cases. Conclusion: There are seven clinical conditions that may cause DGS: ischiofemoral impingement, piriformis syndrome, gemelli-internal obturator syndrome, posterior femoral cutaneous nerve entrapment, superior gluteal nerve entrapment, pudendal neuropathy, and proximal hamstring syndrome. Therefore, DGS is an “umbrella term” that encompasses different pathologies resulting in very similar clinical presentations. In the athletic population, the two most frequent conditions are pudendal neuropathy and proximal hamstring syndrome.
G. Bisciotti, A. Bisciotti, R. Zini et al.· Muscles Ligaments and Tendon...· 0 citations
USG provides improved detection of osteophytes and offers additional information on soft-tissue and early structural changes in knee OA and serves as a valuable, accessible adjunct to conventional radiography for comprehensive evaluation and early diagnosis of knee OA.
R. Rajkumar, E. D. K. Naidu, Gowthaman Nambiraj et al.· Journal of Clinical and Diag...· 0 citations
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
Unknown authors· International Journal of Med...· 0 citations
Accuracy of knee effusion diagnosis is improved with US, particularly in patients with elevated BMI or small effusions, and is useful for arthrocentesis planning, and is useful for arthrocentesis planning.
Ahmed Ibrahem, Sarah Cribby, Chris Penney et al.· Journal of Rheumatology· 0 citations