The goal of this study was to evaluate the necessity of obtaining plain radiographs in the management of lateral epicondylitis. The author reviewed a consecutive series of 294 radiographs in patients with a diagnosis of lateral epicondylitis. Three radiographic views were obtained, AP lateral and radiocapitellar projections. All patients had a duration of symptoms of 3 months. All patients had a clinical examination consistent with lateral epicondylitis. The results demonstrated that 47 abnormal findings were present. No radiograph had more than one abnormal finding. The most common finding was a faint calcification along the lateral epicondyle, seen in 20 individuals. Interestingly, of those 20 patients, only 11 had a steroid injection prior to the radiograph being taken. The second most common finding was spur formation of the coronoid process seen in 14 patients. The radiographs changed the diagnosis in less than 1 percent of cases. This only occurred incases of osteochondritis dissecans of the capitellum.
The study concludes that routine radiographs contribute to the diagnosis and management of lateral epicondylitis in less than 1% of cases. They should probably be reserved for unusual cases with atypical histories or clinical findings suggesting other possible diagnoses (e.g. loss of motion, crepitation, individuals not in middle-age, etc.) Radiographs may also be indicated in refractory cases or in the small percentage of individuals considering surgical intervention.
Journal of Shoulder and Elbow Surg