A 46-year-old tennis player presented with chronic lateral elbow pain .MRI shows the following features.Which clinical test can be used in the diagnosis of this condition?
A. Cozen’s test
B. Allen’s test
C. Drawer test
D. Finkelstein’s test
Ans:A. Cozen’s test .
The patient in question is suffering from Tennis Elbow(Lateral Epicondylitis).
Image shows:MRI of the elbow shows thickening and high signal intensity within the common extensor tendon origin (small arrows). Note that the underlying proximal attachment of the ulnar band of the lateral collateral ligament (large arrow) is intact but is thickened and irregular.
- Lateral epicondylitis is a pathologic condition of the common extensor tendon at its origin from the lateral epicondyle.
- The condition is primarily seen in athletes between 40 and 60 years of age. Lateral epicondylitis is also known as tennis elbow since over 50% of tennis players develop the condition at one time or another. Athletes with lateral epicondylitis present with chronic lateral elbow pain exacerbated by activities that require resisted extension of the wrist.
- The condition is thought to represent an incomplete healing response to an initial microscopic or macroscopic avulsion injury of the common extensor tendon origin.
- Lateral epicondylitis typically involves the tendon origins of the extensor carpi radialis brevis muscle and occasionally extensor digitorum communis and extensor carpi radialis longus muscles from the lateral epicondyle.Most athletes with lateral epicondylitis are easily diagnosed using clinical history and physical examination.
- Cozen’s test is a physical examination performed to evaluate for lateral epicondylitis or, tennis elbow. The test is said to be positive if a resisted wrist extension triggers pain to the lateral aspect of the elbow owing to stress placed upon the tendon of the extensor carpi radialis brevis muscle. The test is performed with extended elbow. .
- However, MRI may be useful for determining the extent of tissue damage to the common extensor tendon origin and to exclude other causes of lateral elbow pain in patients who do not respond well to conservative treatment. The normal common extensor tendon origin shows homogenous low signal intensity on both T1-weighted and T2-weighted images. The common extensor tendon origin in athletes with lateral epicondylitis is usually thickened and shows increased T1 and T2 signal intensity. In individuals with severe lateral epicondylis, the common extensor tendon origin may be thinned and show areas of intense fluid-like signal intensity on T2-weighted images.