Ultrasound vs MRI for Detecting Tennis Elbow Tears

Ultrasound vs MRI for Detecting Tennis Elbow Tears

Tennis elbow, clinically known as chronic lateral epicondylitis, is an affliction often seen in patients between ages 35 and 60. Ironically, despite its name, only about 20 percent of tennis players actually experience tennis elbow. Tennis elbow symptoms arise from placing force loads on muscles and tendons that are not conditioned to handle the stress. Tennis elbow can arise from a number of activities, including:

  • playing tennis
  • use of tools demanding rotational torque, such as screwdrivers
  • carrying heavy loads with extended elbows
  • shoveling snow
  • exercise using heavy weights or body weight

When arising from playing tennis, chronic lateral epicondylitis is often the result of deficient stroke mechanics.

What Exactly is Chronic Lateral Epicondylitis?

CLE is an overuse injury involving the muscles in your forearm that extend your wrist. Those muscles attach to the epicondyle of the humerus bone, located just above and behind your elbow joint. When subjected to repetitive force, as when repeatedly swinging a tennis racquet and encountering resistance from the ball, the tendons and muscles can become inflamed and may even tear. In particular, the extensor carpi radialis brevis (known as the ECRB), is often the afflicted tendon.

Symptoms of tennis elbow include:

  • tenderness around the bony knob near the outside of your elbow
  • pain ranging from mild to debilitating
  • difficulty performing tasks like carrying grocery bags, shaking hands, or even holding a coffee cup

The severity of your symptoms often correlates with the severity of your injury.

Diagnosis of Chronic Lateral Epicondylitis

While the symptoms of tennis elbow are such that diagnosis is a no-brainer, the severity of your injury is another matter. You may simply have tendinitis, which is inflammation of the tendon, and which can be quite painful but not serious. However, you may actually have a tendon rupture (tear) which can range from low grade to high grade.

The only way to determine the severity of your injury is through imaging via Magnetic Resonance Imaging (MRI) or Ultrasonography (US). But which is best?

Study: US vs MRI to Detect Tennis Elbow Tears

In a very recent Polish study published July 27, 2017, the research team set out to compare the performance and reliability of US compared to MRI in detecting tennis elbow tendon tears in patients complaining of chronic lateral epicondylitis (CLE).

Participants were 58 patients who underwent both MRI and US. Injuries were categorized as no tear, suspected tear, low-grade tear and high-grade tear. US was shown to have moderate agreement with MRI in each category, with the highest values detecting low-grade and high-grade tears.

The researchers concluded that Ultrasonography is a valuable and reliable screening tool for detected tendon tears associated with tennis elbow. This is an important finding, as MRI is expensive compared to ultrasound, and much less comfortable for the patient.

Get Help for Your Tennis Elbow

If you are suffering from elbow pain that you suspect may be chronic lateral epicondylitis, ignoring it or hoping it will go away can actually result in increased pain and worsening of your injury. The sports medicine specialists at NYDNRehab can quickly evaluate your injury using ultrasound imaging, and can prescribe and implement a plan of treatment that will put you on a rapid road to recovery.

If you are a tennis player, deficient stroke mechanics may be the root cause of your tennis elbow. Let the experts at NYDNRehab help you to up your game by analyzing your stroke using computer technology, and coaching you to perfection with virtual imaging.

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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