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Lateral Epicondilopathy and ESW. B-mode Ultrasound, Power
Doppler and Pulse Doppler in the Evolution and Prognosis in
Tendinopathy. Development Work
Juan Maria Alarcon Garcia, Adolfo Santos Lian
Institution: Ibermutuamur, Spain
Device and producing company: Epos Ultra Dornier
Introduction: To describe structural characteristics and sonographic alterations of the
common extensor tendon (CET) pre and post ESW treatment. lateral epicondylopathy, is
a tendinopathy caused by overuse. Affecting the common extensor tendon (CET). It is
widely accepted that the deeper and more anterior fibers belong to the extensor carpi
radialis brevis, and those closest to the surface belong to the extensor digitorum.
Moreover, it is thought that the extensor digiti minimi and extensor carpi ulnaris
contribute to tendon formation to a much lesser extent.
Methods: In patients, we determined; sonographic CET thickness, morphologic
characteristics, and alterations; and color Doppler measurements of the epicondylar
artery width and peak systolic velocity. Age, sex, epicondylalgia history, activities (work),
and dominant and non dominant elbows were noted.
We performed U.S pre and post treatment with esw. Focal system.
Results: We have a homogeneus group of work accident pathology. All the group had
history of tennis elbow. All the group, 100 % was studied by ultrasound, B and PW
doppler. 50 %with peak sistolic study. all cases, were dominant elbow.
100% we find images compatibles with epicondilophaty in grade I %; II %; III % and
none in IV degree.
Alteration in vertex %. Calcium %. Deep fibrilar pattern alteration % located in the
posterior área in % and % in lateral área. We check this images in longitudinal and
Morphologic abnormalities were found in 79.5% of patients with a history of
epicondylalgia; 7.7% with no history had abnormalities; and 55.9% with abnormalities
but no history were older than 55 years. Bone spurs (49.2% versus 16.4% [P < .001]),
tendon calcifications (21.5% versus 3.9% [P < .001]), and bone cortex abnormalities
(12.3% versus 1.7% [P < .001]) were found more often in non-normal elbows; 79.4% of
bone spurs in normal elbows occurred in patients older than 55 years.
We get good/ excelent results in 90.02 % of cases in pain.
Discussion: Lateral epicondylopathy is a progressive clinical process resulting in
progressive and secuential sonographic changes. We also believe that some of the
sonographic alterations thought to be associated with the disease could appear in those
who have never had it.
We believe, ultrasound is a real good way for diagnosis, location and following the
We try to detect as prognosis pre treatment depending of the peak sistolic study by
pulse doppler.
Conclusion: b US is an excelent in the treatment of esw. Power doppler helps to
determinate the prognosis of evolution. Peak sistolic/ pulse doppler helps us in the
pronosis and the evolution of flow an resistence index.
We can predict the result before using esw.