DEfining Tennis Elbow CharacTeristics (DETECT)
Research type
Research Study
Full title
DEfining Tennis Elbow CharacTeristics (DETECT)
IRAS ID
245692
Contact name
Chris Smith
Contact email
Sponsor organisation
RD&E NHS FT
Duration of Study in the UK
0 years, 8 months, 7 days
Research summary
Summary of Research
A cross-section feasibility study of 30 individuals (60 elbows), whereby the normal prevalence of elbow extensor tendon tears, neovascularization, calcific deposits and high signal changes on MRI will be assessed. Each participant will undergo an USS and MRI of both right and left elbows, coordinated by an experienced musculoskeletal radiologist. Participants will also complete a standardized questionnaire screening for elbow symptoms and general health complaints.Summary of Results
People with Tennis Elbow suffer with pain on the outside of their elbow. It is a common condition, particularly in middle age. It is associated with repetitive activities involving the forearm, as well as heavy lifting and use of certain tools. When people see a doctor about tennis elbow, they are asked questions and examined but increasingly they might be sent for a scan, either an ultrasound or an MRI. The scan looks for tears in the tendon at the elbow or signs that the tendon is damaged or weak. These changes are often seen in people suffering with Tennis Elbow and can support the diagnosis. However, nobody has ever scanned the elbows of those without any pain to see if these changes are sometimes just a normal part of aging. Our study aimed to find out if these changes exist in people without elbow pain, to help us understand what is normal and what is abnormal in the elbow. This information could be used to improve the way we diagnose and treat tennis elbow. We also hoped that our experience of carrying out this small study would help in the design and running of larger studies. Funding to cover the costs of the study was provided by the British Shoulder and Elbow Society (BESS).We recruited thirty healthy volunteers between the ages of 35 and 65 who all agreed to undergo MRI scans of both their elbows at our purpose-built research building. Due to the COVID-19 pandemic, we only invited people working within the NHS to avoid participants attending the hospital just for the study.
Each participant had no elbow pain, no history of tennis elbow and no previous injuries to their elbow. Before their MRI scan they completed a questionnaire recording demographic information (age, gender, hand dominance, occupation, height, weight) and questionnaires about pain, function and general health (qDASH, PROMIS and EQ-5D-5L).
Participants had MRI scans of both elbows, which were reviewed by two radiologists specialised in interpreting MRI imaging of bones and muscles. The radiologists were asked separately to score the degree of damage to the tendons and ligaments at the elbow using a standardised scoring scale.The thirty volunteers were grouped according to their age; ten were aged 35 to 45, eleven were aged 45 to 55 and nine were aged 55 to 65. There was an equal male to female split. The questionnaires found that none of the participants were troubled by elbow pain, and all considered themselves to be in good overall heath. Two volunteers could only tolerate a single elbow MRI due to discomfort in the scanner.
When reviewing the results, we focused on one tendon in particular – the Common Extensor Tendon (CET)– which is the tendon most associated with Tennis Elbow. 11 of 30 volunteers (37%) had evidence of tendon damage on MRI in one or both of their CETS. The proportion of volunteers with these abnormal findings increased with age; 35 to 45 (10%), 45 to 55 (36%), 55 to 65 (67%). Similarly, the proportion of abnormal scans increased with BMI classification; healthy (25%), overweight (43%), obese (67%). In more than half of cases MRI changes were seen in both elbows. Changes were typically ‘mild’ or ‘moderate’, with a single volunteer showing evidence of a ‘severe’ injury at CET.
These results are interesting as they suggest that damage to this tendon is relatively common in healthy people who have no pain in their elbows. This tendon damage is found more frequently as people get older and with increasing BMI. This information forces us to reconsider the value of MRI scans, which are expensive, in diagnosing tennis elbow. It also suggests we must think more carefully when using the results of MRI to decide on treatments, including surgery. The success of this small study in achieving its aims would support the idea of carrying out a similar study on a larger scale to confirm these findings and compare with ultrasound scanning. Using this information, we hope in the future to create a classification system for assessing the severity of Tennis Elbow, which would have great use in clinical practice and future research studies.REC name
London - Bloomsbury Research Ethics Committee
REC reference
19/LO/1995
Date of REC Opinion
13 Feb 2020
REC opinion
Further Information Favourable Opinion