Tennis elbow is a common condition affecting the elbow. When symptoms arise, individuals often wonder about the best way to determine the cause, including whether specific imaging techniques like magnetic resonance imaging (MRI) are necessary. Understanding tennis elbow and its diagnostic approaches clarifies the role of advanced imaging.
What is Tennis Elbow?
Tennis elbow, medically known as lateral epicondylitis, is an overuse injury impacting the tendons on the outer side of the elbow. These tendons, primarily from the extensor carpi radialis brevis muscle, connect the forearm muscles to the humerus bone in the upper arm. Repetitive motions involving the arm and wrist, especially those requiring gripping or twisting, can strain these tendons, leading to microscopic tears and degeneration. Common symptoms include pain or burning around the outside of the elbow, which can spread down the forearm, along with tenderness and sometimes a weakened grip.
Diagnosing Tennis Elbow: The Clinical Approach
Diagnosing tennis elbow begins with a clinical evaluation by a healthcare provider. This involves taking a detailed patient history, inquiring about the onset of pain, aggravating activities, and any previous injuries. A physical examination is then conducted, where the provider will palpate the outer elbow to locate tenderness. Specific movements that reproduce pain, such as resisted wrist extension or gripping, also help confirm the diagnosis. In most instances, a thorough history and physical exam are sufficient to diagnose tennis elbow, making imaging tests not the initial step.
MRI for Tennis Elbow: What It Shows and When It Is Used
An MRI can show changes associated with tennis elbow, providing detailed images of the soft tissues, bones, and nerves around the elbow. This imaging technique can reveal signs of tendon degeneration, often called tendinosis, characterized by abnormal thickening and altered signal intensity within the common extensor origin. An MRI can also detect partial or, rarely, complete tears within the extensor tendons, along with inflammation or fluid accumulation around the affected area.
While an MRI offers detailed insights, it is not typically ordered for every case of tennis elbow. It becomes useful when the diagnosis remains unclear after a clinical examination, or if symptoms are severe, persistent, and do not improve with conservative treatments over several months. An MRI can also help rule out other conditions that cause similar elbow pain, such as nerve compression (like radial tunnel syndrome), stress fractures, or cartilage injuries. It can also be used for surgical planning, offering a comprehensive view of the extent of tendon damage and any coexisting issues.
Other Imaging Techniques
Beyond MRI, other imaging techniques may be used to evaluate elbow pain, each serving a different purpose. X-rays are commonly employed to assess bone structures and are effective at ruling out issues like fractures, dislocations, or arthritis. However, they do not clearly show soft tissue damage such as tendon injuries. Therefore, an X-ray would not directly show tennis elbow itself but can exclude other causes of pain.
Ultrasound is another imaging modality that can visualize soft tissues like tendons in real-time. It can identify tendon abnormalities such as thickening, tears, or calcifications characteristic of tennis elbow. Ultrasound is often accessible and cost-effective, sometimes serving as an alternative to MRI for evaluating tendon issues, especially since it allows dynamic assessment of the affected area.