Page 7 - MSK assignment

7 F. Elahi

other athletes that perform similar movements (Buchanan &
Matthew, 2019). Another form of tendinosis in the elbow is medial
epicondylitis, also known as epitrocleitis, golfer’s elbow, medial
tennis elbow, or pitcher’s elbow. Golfer’s elbow is the degeneration
of the common flexor tendon relative to the flexor-pronator
muscles. Often sport related injuries such as golfing, javelin
throwing, or similar actions cause the degeneration (Bianchi &
Martinoli, 2007). Patients with tendinosis present with an onset of
pain increasing over a period of time. The patient’s history is
crucial to form an indication of tendinosis. Most patients
complain of pain on the lateral aspect of the elbow. Symptoms
exacerbate with activity and lessen with rest. (Buchanan &
Matthew, 2019).

Ultrasound diagnosis for tennis elbow and golfer’s
elbow portrays calcifications, intrasubstance tears, and
irregularity of the lateral epicondyle. Another indication is the
thickening and heterogeneous appearance of the tendons
(Buchanan & Matthew, 2019). The most common appearance
is a focal hypoechoic region in the deep aspect of the tendon
which ranges from 3 to 15mm. Often a loss of the fibrillar
pattern is also an indication of tendinosis (Connell et al.,
2001). Figure C is an example of the hypoechoic region that
would indicate tendinosis. Figure D portrays two calcifications
which also indication tendinosis. Thickening of the tendon can
be seen alongside the hypoechoic regions in some cases,
such as Figure E.

Joint Effusion
Elbow joint effusion is an increase in intra-articular fluid
in the joint. The etiology of the effusion can range from trauma,
infection, arthritis, and other joint pathologies (​De Maeseneer
et al., 1998). One of the most common causes is arthritis. Joint
effusion only applies to synovial joints. ​Symptoms of joint
effusion include pain, stiffness, and/or swelling. Since it is an
inflammatory process, it could present with heat or redness.
When joint effusion is seen in the elbow with a trauma, it is
often a sign of an occult fracture (Dixon & Bell, n.d.).

Ultrasound is effective for diagnosing joint effusions
due to the high sensitivity. Joint effusion in the elbow can be
seen at the anterolateral aspect, at the radiocapitellar joint
area, or at the posterior aspect of the triceps tendon. When