This is a retrospective review of eleven elbows in eleven patients with refractory tennis elbow. The authors performed MRI T2 imaging of the elbows, which demonstrated six of the eleven had a high-signal intensity focus in the tendon of the ECRB at the lateral epicondyle. The other five elbows showed various normal findings on the MRI. Two of the five had edema, but no evidence of granulation tissue. One demonstrated an osteochondral fracture of the capitellum, another a ganglion arising off of the radial nerve. The six patients with the high-signal focus underwent surgical intervention. All patients with positive findings demonstrated granulation tissue with histologic evidence of lateral epicondylitis.
This study suggests that MRI may have a role in distinguishing which patients have a clinically relevant lateral epicondylitis. The number of patients is small and it seems difficult to imagine that an imaging study can predict outcome in this poorly understood tendinopathy. It would not seem cost effective to use MRI to diagnose or to choose which patients are candidates for epicondylitis surgery based on this series until further information is available.
J Shoulder Elbow Surg