Ultrasonographic evaluation of the radial nerves in patients with unilateral refractory lateral epicondylitis

Abstract

OBJECTIVE.: To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. DESIGN.: Cross-sectional study. SETTING.: Three physical medicine and rehabilitation departments. SUBJECTS.: Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. METHODS.: All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. RESULTS.: When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P <0.001). Grip strength values were lower on the affected sides (P <0.001). Electrophysiological studies were all normal, and similar between the two sides (all P >0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P <0.01). CONCLUSIONS.: Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment.