Ultrasound vs MRI for Detecting Tennis Elbow Tears

Learn about the causes and symptoms of chronic lateral epicondylitis, other conditions that mimic its symptoms, and why high resolution ultrasonography is far superior to MRI for diagnosing and treating elbow injuries.

Lateral Epicondylitis: a Medical Misnomer

In medical jargon, the suffix “itis” indicates an inflammatory condition, but in the case of lateral epicondylitis — as well as other tendon pathologies – this is usually a misnomer. In general, tendon tissue is avascular, meaning it has a limited blood supply, and microscopic evaluation of tendon tissue rarely shows signs of inflammation. In most cases, tendon injuries are marked by the degeneration of fibroblasts and disarray of collagen fibers.

While standard treatments for inflammation – such as ice, compression and NSAIDs – may help to soothe tennis elbow symptoms in the short run by desensitizing nerves, long-term relief requires a multifaceted approach aimed at realigning collagen fibers and rehabilitating the affected structures.

Tennis Elbow Onset and Symptoms

Early symptoms of tennis elbow begin as pain over the lateral elbow that intensifies during activity and abates during rest. Pain usually arises within 24-72 hours after repetitive wrist extension, with maximum tenderness upon palpation of the extensor carpi radialis brevis (ECRB), which is often the afflicted tendon. Even with reduced activity, tennis elbow symptoms can persist for months, with some cases taking over a year to resolve.

Despite its sporty nickname, lateral epicondylitis symptoms can be caused by a variety of activities, including:

• Using hand tools that require rotational torque, like a screwdriver or manual drill
• Painting walls, which requires loading the wrist extension
• Carrying heavy loads with an extended elbow
• Snow shoveling
• Use of dental tools
• Exercise and weight lifting with poor form
• Tennis and other racquet sports
• Activities that hyperextend the wrist

Tennis elbow symptoms include:

• Tenderness around the lateral elbow
• Pain ranging from mild to debilitating
• Pain and tenderness that increases with activity
• Difficulty performing tasks that load the elbow, like carrying grocery bags, shaking hands, or even holding a coffee

The intensity of tennis elbow symptoms often correlates with the severity of injury.

Chronic Lateral Epicondylitis Diagnosis

In conventional medicine, imaging is rarely used for diagnosis of tennis elbow. Instead, doctors rely on reported symptoms and results from the clinical exam. Only when treatments fail to alleviate persistent symptoms is MRI considered, to look for other causes such as osteophytes, degenerative joint disease, osteochondritis dissecans, or stress fractures, all of which share the same symptoms. However, in many cases, the limitations of MRI make it an impractical and ineffective diagnostic tool.

MRI’s shortcomings include:

• Expensive equipment that makes on-site MRI prohibitive for small healthcare entities
• Immobile equipment with large space requirements
• MRI frequently produces loud noises that can harm hearing
• MRI’s small enclosed environment can be claustrophobic for some patients
• MRI requires the patient to remain perfectly still for extended periods ranging from 45 minutes to 2 hours
• Patients experience lengthy delays between the imaging session and lab results, prolonging the time between initial examination and treatment
• Poses health risks for patients with device implants and orthopedic hardware
• High cost of imaging for patients
• Patient inconvenience

By comparison, ultrasonography provides a clinically-friendly diagnostic tool, with more extensive capabilities than MRI.

Advantages of diagnostic ultrasonography include:

• Affordable equipment compared to MRI
• Minimal space requirement
• Highly portable equipment that can be used under a variety of conditions — in office, on the athletic field, or on the battlefield
• Imaging can be viewed in real time
• Ultrasound transducers can follow the path of long structures like muscles, nerves and blood vessels
• Imaging can be done with the patient in motion, to view the interactions of various structures
• Capabilities for sonoelastography enable the assessment of tendon and fascia tissue density
• Capabilities for superb microvascular imaging enable detection of microscopic blood vessel activity – an early sign of healing
• Ultrasound allows for comparison of the injured and uninjured elbow in the same session
• Minimal patient discomfort and optimal convenience
• Substantially less expensive for patients than MRI

In addition, high resolution dynamic ultrasonography can distinguish tendinopathy from tendon ruptures. In most cases, patients with tendon tears also have partial ligament tears and/or ligament laxity, conditions that are difficult to visualize with MRI.

According to recent research, a unique imaging technique called stress ultrasonography can directly visualize the ulnar collateral ligament (UCL) – an elbow ligament that is frequently injured during repetitive overhead movements. Stress ultrasonography allows for assessment of ligament laxity, a distinct advantage over MRI.

Conditions that Mimic Tennis Elbow

A significant disadvantage of symptoms-based diagnosis is that other less common contributing factors may be overlooked. In fact, research indicates that, due to inappropriate handling of the condition, a substantial number of patients diagnosed with lateral epicondylitis do not experience positive therapeutic outcomes.

Lateral epicondylitis is only one of many conditions that affect the lateral elbow region and exhibit the same symptoms as tennis elbow. Failure to consider alternative causes of tennis elbow symptoms can prolong the patient’s suffering and potentially worsen the condition.

Conditions that mimic tennis elbow include:

• Edema
• Fascial densifications
• Degenerative arthritis
• Rupture of wrist extensor muscles attached to the lateral epicondyle
• Stress fractures
• Posterior interosseous nerve (PIN) entrapment at the arcade of Frohse
• Posterior branch of lateral antebrachial nerve entrapment
• Plica syndrome – irritation of synovial tissue in the elbow joint

Diagnostic ultrasound enables the clinician to thoroughly examine the elbow and its surrounding tissues and structures. With dynamic ultrasound, doctors can assess how the various structures interact while in motion, compare the injured and uninjured elbows, and test for tissue laxity using sonoelastography.

On-Site High-Resolution Ultrasonography for Tennis Elbow Diagnosis in NYC

If you’ve ever had an MRI scan, you know what a costly and uncomfortable ordeal it can be. In many cases, doctors are unable to detect tissue damage based on MRI, making the procedure a total waste of time and money.

The clinic at NYDNRehab features the highest resolution ultrasound equipment currently available, with capabilities for sonoelastography and microvascular imaging. Our clinical director, Dr. Lev Kalika, is a recognized expert in diagnostic ultrasonography, credited with multiple scientific publications on the procedure.

to get personalized treatment plan that gets fast results contact NYDNRehab today

Request an appointment » Our location: 11 West 25th Street 5th floor, New York, NY 10010

If you suffer from chronic lateral epicondylitis or other chronic pain syndromes, we conduct same-day diagnostic ultrasound imaging in the comfort of our Midtown Manhattan clinic, for a fraction of the cost of MRI.

Contact NYDNRehab today to get a quick and accurate diagnosis, and a personalized treatment plan that gets fast results.