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Relationship between ultrasound detected tendon abnormalities, and sensory and clinical characteristics in people with chronic lateral epicondylalgia


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Palaniswamy, V, Ng, S-K, Manickaraj, N, Ryan, M, Yelland, M, Rabago, D and Bisset, L 2018 , 'Relationship between ultrasound detected tendon abnormalities, and sensory and clinical characteristics in people with chronic lateral epicondylalgia' , PLoS ONE, vol. 13, no. 10 , pp. 1-18 , doi: 10.1371/journal.pone.0205171.

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ObjectiveTo investigate the relationship between tendon structural changes determined by static ultrasound images (US) and sensory changes using quantitative sensory testing (QST), and clinical measures in lateral epicondylalgia.Materials and methodsBoth elbows of 66 adult participants with a clinical diagnosis of lateral epicondylalgia were investigated. Using a standardised ultrasound image rating scale, common extensor hypoechogenicity, heterogenicity, neovascularity, and bony abnormalities at the enthesis were scored, and tendon thickness (longitudinal and transverse plane) was measured by a trained assessor. Sensory measures of pressure, heat and cold pain thresholds and vibration detection threshold were recorded. Pain and function were assessed using the patient-rated tennis elbow (PRTEE), pain-free grip strength, pain visual analog scale (PVAS) and quality of life (EuroQoL EQ -5D). Univariate and multivariate linear regression analyses were used to explore the association between tendon structural, sensory and clinical variables which were adjusted for age, gender and duration of symptoms.ResultsA negative correlation was identified between the presence of neovascularity and cold pain threshold (P = 0.015). Multiple regression analyses revealed that a combination of female gender (P = 0.044) and transverse tendon thickness (P = 0.010) were significantly associated with vibration detection threshold in affected elbows, while gender (P = 0.012) and total ultrasound scale score (P = 0.024) were significantly associated with heat pain threshold and vibration detection threshold in unaffected elbows. Heat pain threshold and gender were significantly associated with pain and disability (PRTEE; P ConclusionGenerally, structural and sensory measures were weakly correlated. However, neovascularity and transverse tendon thickness may be related to sensory system changes in LE.

Item Type: Article
Authors/Creators:Palaniswamy, V and Ng, S-K and Manickaraj, N and Ryan, M and Yelland, M and Rabago, D and Bisset, L
Keywords: diagnostic ultrasound, tendon, tennis elbow, lateral epicondylalgia, pain, quatitative sensory testing
Journal or Publication Title: PLoS ONE
Publisher: Public Library of Science
ISSN: 1932-6203
DOI / ID Number: 10.1371/journal.pone.0205171
Copyright Information:

Copyright: © 2018 Palaniswamy et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License, ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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