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Purpose: This research aims to determine the inter-tester reliability of sonographers in detecting presence of lesions in the elbows of participants with Lateral Epicondylar Pain (LEP) using the Musculoskeletal Ultrasound (MSUS) and in measuring the internal dimensions of the Radial Nerve at various points in the upper extremities. Methods: Two healthcare professionals who are experienced in MSUS and a musculoskeletal researcher agreed on the diagnostic sonographic features of LEP. Evidence of lesions was sought on the common extensor tendon (CET), lateral epicondyle, lateral collateral ligament, and distal biceps tendon. Measurements on the internal widest dimensions of the radial nerve at specified points were gathered. Results: There was perfect agreement between the two healthcare professionals in detecting bony irregularities on the lateral epicondyle and strong agreement on the presence of neovascularity in CET. The inter-tester reliability in assessing the internal architecture of the common extensor tendon ranged from poor (CET's margin and fibrillar pattern) to fair (for adjacent fluid and intratendinous calcifications). There were no significant differences between sonographers in measuring the Radial Nerve except for the Posterior Interosseous Nerve. Conclusions: Differences in MSUS assessment on CET's tendon margin and fibrillar pattern and the measurement of PIN between experienced healthcare professionals in MSUS scanning and interpretation highlight the need for standardized protocol.

Background: The aim of this study is to determine the effect of elbow and forearm position on the resisted wrist extension test (RWET) in patients with lateral epicondylitis. We also looked at the incidence of associated sensory disturbance of the superficial radial nerve (SRN) and the effect of treatment of lateral epicondylitis on sensory disturbance.

Methods: Sixty-three consecutive patients (68 limbs) with lateral epicondylitis and an equal number of age and gender matched volunteers were investigated. Patients with lateral epicondylitis were subdivided into two groups based on history of corticosteroid injection. We performed the RWET in four limb positions namely elbow extended and forearm pronated (EP), elbow flexed and forearm pronated (FP), elbow extended and forearm supinated (ES), elbow flexed and forearm supinated (FS). Sensory disturbance in the SRN was assessed using a Wartenberg pin wheel.

Results: The positivity rate of the RWET was significantly higher in the EP position (100%) compared to the FP (66%), ES (62%) and the FS (24%) positions in limbs with lateral epicondylitis. The RWET was positive only in one subject in the EP position in the control group (1.5%). Sensory disturbance in the SRN territory was present in 63.2% of limbs and only two subjects (2.9%) in the control group. The incidence of sensory disturbance was significantly higher (74.5% vs. 48.3%, p < 0.05) in patients who did not have a corticosteroid injection.

Conclusions: The sensitivity and specificity of the RWET is better when it is performed with the elbow in extension with the forearm pronated (EP); 63.2% of limbs with lateral epicondylitis were noted to have an associated sensory disturbance of the SRN and a corticosteroid injection seems to decrease the incidence of sensory disturbances.

Level of Evidence: Level II (Diagnostic)

Background: Infiltration is one of the treatment options for lateral epicondylosis, a degenerative process in the tendon of the musculus extensor carpi radialis brevis. The aim of this study was to evaluate the clinical outcome of a standardised fenestration technique, the Instant Tennis Elbow Cure (ITEC) technique, with injection of betamethasone versus autologous blood.

Methods: A prospective comparative study was performed. Twenty-eight patients received an infiltration with 1 mL betamethasone, in combination with 1 mL 2% lidocaine. Twenty-eight patients received an infiltration with 2 mL autologous blood. Both infiltrations were administered using the ITEC-technique. The patients were evaluated at baseline, 6 weeks, 3 months and 6 months using Visual Analogue Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE) and Nirschl staging.

Results: At the 6-week follow-up, the corticosteroid group showed significantly better results for VAS. At the 3-month follow-up, no significant differences were observed for all three scores. At the 6-monthfollow-up, the autologous blood group showed significantly better results for all three scores.

Conclusions: Standardised fenestration using the ITEC-technique with corticosteroid infiltration is more effective in reducing pain at the 6-week follow-up. At the 6-month follow-up, the use of autologous blood is more effective in pain reduction and functional recovery.

Level of Evidence: Level II