Physical Medicine and Rehabilitation for Epicondylitis Workup

Updated: Aug 30, 2018
  • Author: Sharon J Gibbs, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Workup

Laboratory Studies

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  • Laboratory studies are generally not indicated in ME.

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Imaging Studies

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  • A radiograph of the elbow is often performed to rule out associated lesions (eg, loose bodies, bony avulsion, osteoarthritis). Typically, anteroposterior and lateral films are adequate.

  • Oblique views are needed if loose bodies are suggested upon examination or because of a catching or clicking sensation described by the patient.

  • Valgus stress radiographs should be obtained if medial instability is suggested.

  • Magnetic resonance imaging (MRI) may be helpful in looking for the characteristic pathology that is seen in chronic cases of ME; MRI also permits assessment of the medial collateral ligament and ulnar nerve. [7] Although in most cases an MRI scan is not necessary, it should be considered in individuals with atypical symptoms or in patients who are not responsive to conservative measures.

  • Research suggests that ultrasonography also is useful for the diagnosis of ME. In a prospective, single-blind study, Park et al found that ultrasonographic findings were positive in 20 of 21 elbows with ME and were negative in 23 of 25 elbows without ME. [8] According to the investigators, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ultrasonography in the diagnosis of clinical ME were, respectively, 95.2%, 92%, 93.5%, 90.9%, and 95.8%. They therefore recommended that ultrasonography be considered as an initial imaging modality in the evaluation of ME.

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Other Tests

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  • If ulnar nerve involvement is suggested, a nerve conduction study and electromyography should be performed.

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