Suspected tennis elbow - When does diagnostic imaging help?

In addition to tennis elbow, a variety of conditions can lead to pain at the outer elbow. A detailed anamnesis and examination of the elbow usually make it possible to identify the potential causes (differential diagnoses) on the basis of significant symptoms and findings.
Restrictions in passive/active movement, for example, may be an indication of tendon damage, free joint bodies or a plica (fold of the synovial membrane).
If there is numbness in the fingers, nerve compression or cervical spine problems are suspected.

Imaging is not necessary for a clear clinical diagnosis of tennis elbow.¹ Diagnostic imaging may be useful to clarify possible differential diagnoses or concomitant pathologies.⁵
An ultrasound examination allows diseases of the tendons or ligaments (e.g. tennis/golfer's elbow, elbow instability) and the pinching plica to be dynamically visualised.
X-rays are used, among other things, to visualise calcification and arthrosis, or are used in cases of suspected fractures and related complications.
Both MRI (magnetic resonance imaging) and CT (computerised tomography) can contribute important findings to the assessment of the elbow. MRI is particularly useful for imaging tendons and muscles. CT is very helpful in cases of persistent pain after a fracture or suspected free joint bodies.⁶

The findings from imaging procedures enable the targeted application of different therapeutic procedures (e.g. infiltration, surgical decompression).

Keypoints

I. Unspecific complaints and sometimes overlapping symptoms make diagnosis difficult. Close listening/questioning is essential, important key words here are:

• Persistent pain (especially after fracture or in children/adolescents),
• Numbness in the fingers,
• Crepitus during movement,
• Blockage, entrapment or
• Avoidance of movement.^5,6

II. if elbow pain persists (>6 months) and is refractory to treatment, clinical testing and, if necessary, further diagnostics should be used to consider another cause.^2,3

¹ Schneider, M. M. et al., 2018. Tennis elbow - the value of manual and surgical therapy. Manual Medicine, 56 (2), pp. 133-146.
² Vavken, P., 2018. evidence-based treatment of lateral elbow pain. Orthopaedics & Rheumatology, 3, pp. 62-65.
^3Institutefor Quality and Efficiency in Health Care, 2018. gesundheitsinformationen.de. https://www. gesundheitsinformation.de/tennisarm-tennisellenbogen.html [accessed 16 May 2021].
^4Institutefor Quality and Efficiency in Health Care, 2018. gesundheitsinformation.de. https://www.gesundheitsinformation.de/wie-wird-ein-tennisarm-behandelt.html [accessed 16 May 2021].
^5Vavken, P. & Rosso, C., 2017. the aching elbow in practice. Swiss Medical Forum, 17(44), pp. 953-959.
⁶ Vavken, P. & Rosso, C., 2019. The examination of the elbow in the athlete. Swiss Sports & Exercise Medicine, 67(3), pp. 26-32.