Radiographic calcifications in lateral epicondylitis

SUBMISSION – NEHS 2014 Radiographic calcifications in lateral epicondylitis Shillito M, Martin N, Soong M BACKGROUND Prior literature suggests that radiographs are unnecessary for the initial evaluation of lateral epicondylitis, as treatment decisions are rarely altered as a result. The most commonly noted radiographic finding is calcification at the lateral epicondyle, found in up to 22% of cases. We sought to critically examine this radiographic finding in our patients with lateral epicondylitis and determine its possible significance with regard to demographics, symptoms, patient-rated scores, and history of prior steroid injection. METHODS All patients diagnosed with lateral epicondylitis by a single surgeon from 2009-2013 were identified by billing data and retrospectively reviewed. Age, gender, laterality, hand dominance, pain VAS, duration of symptoms, QuickDASH score, and history of prior steroid injection were recorded for each patient. Standard posteroanterior radiographs were evaluated for calcifications at the lateral epicondyle. Analyzed was performed using t-test for continuous data and Fisher’s exact test for categorical data. RESULTS 182 patients were found. 91 (50%) had lateral epicondyle calcifications. Data are summarized below (Table). Only age was significantly different between groups (53.9yrs with calcifications, 47.4yrs without, p<.0001). Calcifications No calcifications p = Age 53.9 47.4 <.0001 Gender (% male) 69.2 58.2 0.165 Laterality (%R) 59.3 57.1 0.881 Dominance (%R) 81.3 82.4 1.000 Pain VAS 5.4 4.9 0.476 Duration (months) 5.0 6.2 0.451 QuickDASH 39.2 43.8 0.092 Prior injection (%) 8.3 8.3 1.000 CONCLUSIONS We found greater prevalence of lateral elbow calcifications than in prior outdated studies of lateral epicondylitis, possibly due to our utilization of modern digital radiography with magnification. We also found that patients with calcifications were significantly older than those without. However, there were no significant differences in other demographics, symptoms, patient-rated scores, or history of prior injection, and thus we agree with prior literature that radiographs are likely not helpful in the management of this common condition.