Validity of musculoskeletal ultrasound for identification of humeroradial joint chondral lesions: a preliminary investigation.

CONTEXT

Epicondylalgia is a common condition involving pain-generating structures such as tendon, neural, and chondral tissue. The current noninvasive reference standard for identifying chondral lesions is magnetic resonance imaging. Musculoskeletal ultrasound (MUS) may be an inexpensive and effective alternative.

OBJECTIVE

To determine the intrarater reliability and validity of MUS for identifying humeroradial joint (HRJ) chondral lesions.

DESIGN

Cross-sectional study.

SETTING

Clinical anatomy research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-eight embalmed cadavers (14 women, 14 men; mean age = 79.5 ± 8.5 years).

MAIN OUTCOME MEASURE(S): An athletic trainer performed MUS evaluation of each anterior and distal-posterior capitellum and radial head to identify chondral lesions. The reference standard was identification of chondral lesions by gross macroscopic examination. Intrarater reliability for reproducing an image was calculated using the intraclass correlation coefficient (3,k) for measurements of the articular surface using 2 images. Intrarater reliability to evaluate a single image was calculated using the Cohen κ for agreement as to the presence of chondral lesions. Validity was calculated using the agreement of MUS images and gross macroscopic examination.

RESULTS

Intrarater reliability was 0.88 (95% confidence interval = 0.77, 0.94) for reproducing an image and 0.93 (95% confidence interval = 0.80, 1.06) for evaluating a single image. Identifying chondral lesions on all HRJ surfaces with MUS demonstrated sensitivity = 0.93, specificity = 0.28, positive predictive value = 0.58, negative predictive value = 0.77, positive likelihood ratio = 1.28, and negative likelihood ratio = 0.27.

CONCLUSIONS

Musculoskeletal ultrasound is a reliable and sensitive tool for a clinician with relatively little experience and training to rule out HRJ chondral lesions. These results may assist with clinical assessment and decision making in patients with lateral epicondylalgia to rule out HRJ chondral lesions.