Connell D, Burke F, Coombes P, McNealy S, Freeman D, Pryde D, Hoy G
Department of Radiology, Victoria House Private Hospital, 316 Malvern Rd., Prahran 3181, Melbourne, Victoria, Australia.
AJR Am J Roentgenol. 2001 Mar;176(3):777-82. doi: 10.2214/ajr.176.3.1760777.
The purpose of this study was to describe the sonographic appearance of the common extensor origin in cadavers and asymptomatic volunteers, and to relate this appearance to the findings in patients with lateral epicondylitis.
Seventy-two elbows in 71 patients with lateral epicondylitis were examined on sonography. Most of the patients (60/71) gave a history of repetitive microtrauma. The injuries were evaluated with respect to location and severity. Focal areas of degeneration, discrete cleavage tears, and involvement of the lateral collateral ligament were identified. Calcification and bony changes were noted. The appearance of the normal common extensor tendon was described, and cadaveric specimens were dissected. Twenty-one patients subsequently underwent surgery.
The normal common extensor origin is composed of longitudinal fibrils bound closely with the extensor carpi radialis brevis constituting most of the deep fibers, with the extensor digitorum making up the superficial part. The lateral collateral ligament can be identified as a discrete and separate band. The most common appearance of lateral epicondylitis is a focal hypoechoic area in the deep part of the tendon (46/72). These focal areas were identified at surgery and corresponded histologically to collagen degeneration with fibroblastic proliferation. Often discrete cleavage planes traversing the tendon were manifest as partial (18/72) and complete (2/72) tears. The lateral collateral ligament was involved in eight of 72 elbows.
Sonography of the common extensor origin can be used to confirm lateral epicondylitis in patients with lateral elbow pain and provide information about the severity of the disease.
本研究旨在描述尸体和无症状志愿者的伸肌总起点的超声表现，并将此表现与肱骨外上髁炎患者的检查结果相关联。
对71例肱骨外上髁炎患者的72个肘部进行超声检查。大多数患者（60/71）有反复微小创伤史。对损伤的部位和严重程度进行评估。识别退变的局灶性区域、离散的劈裂性撕裂以及外侧副韧带受累情况。记录钙化和骨质改变情况。描述正常伸肌总腱的表现，并对尸体标本进行解剖。21例患者随后接受了手术。
正常伸肌总起点由纵向纤维组成，这些纤维与桡侧腕短伸肌紧密相连，构成大部分深层纤维，而指伸肌构成浅表部分。外侧副韧带可被识别为一条离散且独立的束带。肱骨外上髁炎最常见的表现是肌腱深部的局灶性低回声区（46/72）。这些局灶性区域在手术中被识别出来，组织学上对应于伴有成纤维细胞增生的胶原退变。经常可见横穿肌腱的离散劈裂平面表现为部分（18/72）和完全（2/72）撕裂。72个肘部中有8个肘部的外侧副韧带受累。
伸肌总起点的超声检查可用于确诊肘部外侧疼痛患者的肱骨外上髁炎，并提供有关疾病严重程度的信息。
