Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany.
Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece.
J Neuroimaging. 2024 Nov-Dec;34(6):799-803. doi: 10.1111/jon.13244. Epub 2024 Oct 13.
Lateral elbow pain is quite common in everyday life. Lateral epicondylitis and radial tunnel syndrome are the most common causes of lateral elbow pain. The aim of this study was to evaluate the sensitivity and specificity of neuromuscular ultrasound examination in the diagnosis of lateral epicondylitis versus radial tunnel syndrome.
This was a prospective double-blinded pilot study of 68 elbows in 34 patients with lateral elbow pain. Patients underwent clinical examination and standardized neuromuscular ultrasound evaluation in the first 15 days after the initiation of symptoms. Statistical significance was set at p < .001. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Sixty-eight radial nerves were examined in 34 healthy controls (16 males; mean age 48.1 ± 8.2 years). Pain with palpation over the radial tunnel was found in 25 of 48 elbows (52.1%) compared to the pain over the lateral epicondyle found in 10 of 48 elbows (20.8%). Τhe sensitivity of palpation in differentiating radial tunnel syndrome from lateral epicondylitis was 75.7%, while the specificity was 50% (PPV 71.4%, NPV 51.5%). The sensitivity of neuromuscular ultrasound in differentiating radial tunnel syndrome from lateral epicondylitis was 92.6%, while the specificity was 80% (PPV 92.6%, NPV 80.0%). In most of the patients (25/31), fibrous bands anterior to the radio-capitellar joint were responsible for the nerve entrapment.
The present study highlights the importance of the neuromuscular ultrasound's diagnostic role in differentiating radial tunnel syndrome from lateral epicondylitis in the clinical scenario of lateral elbow pain.
日常生活中，肘部外侧疼痛较为常见。外侧上髁炎和桡侧腕管综合征是引起肘部外侧疼痛的最常见原因。本研究旨在评估神经肌肉超声检查在诊断外侧上髁炎与桡侧腕管综合征方面的敏感性和特异性。
这是一项前瞻性、双盲、初步研究，共纳入 34 例肘部外侧疼痛患者的 68 侧肘部。患者在症状出现后的前 15 天内接受了临床检查和标准化的神经肌肉超声评估。统计显著性设定为 p<0.001。计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 34 例健康对照者（16 例男性；平均年龄 48.1±8.2 岁）中，共检查了 68 条桡神经。与 10 侧肘部（20.8%）的外侧上髁压痛相比，在 48 侧肘部中有 25 侧（52.1%）可触及桡侧腕管压痛。触诊区分桡侧腕管综合征与外侧上髁炎的敏感性为 75.7%，特异性为 50%（PPV 71.4%，NPV 51.5%）。神经肌肉超声区分桡侧腕管综合征与外侧上髁炎的敏感性为 92.6%，特异性为 80%（PPV 92.6%，NPV 80.0%）。在大多数患者（25/31）中，桡骨头-尺骨茎突关节前的纤维束是导致神经受压的原因。
本研究强调了神经肌肉超声在临床出现肘部外侧疼痛时区分桡侧腕管综合征与外侧上髁炎中的诊断作用。
