Tendinous Signal Alterations on MRI in the Asymptomatic Elbow: A Retrospective Cross-Sectional Study

TL;DR

This study finds that MRI can show tendon signal changes in asymptomatic elbows, suggesting the need for clinical correlation to avoid unnecessary treatment.

Contribution

The study quantifies the prevalence of asymptomatic tendon signal changes on MRI in the elbow, emphasizing the risk of overtreatment.

Findings

Signal alterations were found in 8% of common flexor tendons on MRI.

No partial or complete tears were observed in any of the examined tendons.

Triceps tendons showed a physiological hyperintense signal in all cases.

Abstract

It is clinically relevant to prevent overtreatment of tendinopathy diagnosed solely on imaging. Therefore, the prevalence of presumable asymptomatic signal changes in the common flexor origin, biceps insertion, brachialis insertion, and triceps insertion were assessed.

Two hundred and five magnetic resonance imaging (MRI) exams of the elbow with coronal and axial fat-saturated fluid-sensitive sequences between January 1, 2018 and July 31, 2022 were retrospectively identified in our center.

Two radiology residents reviewed the exams independently. The elbow tendons were given a score from 0 to 4. Score 0: no signal abnormality; score 1: increased T2-weighted signal around the tendon; score 2: increased T2-weighted signal compared to muscle within the tendon; score 3: partial tear; and score 4: complete tear.

The common flexor tendon showed signal alterations in 8% of patients; nine patients had an increased signal around the tendon, and eight patients had an increased signal within the tendon. Three patients (1.5%) had an altered signal intensity in the biceps tendon. All triceps tendons showed a linear hyperintense signal, suggesting that it is physiological. There were no partial or complete tears. No signal abnormalities were noted in the brachialis tendon among all patients.

The prevalence of presumable asymptomatic signal alterations seen in the common flexor origin on MRI is not negligible; therefore, clinical correlation is advised to prevent overtreatment of tendinopathy in these cases. No partial or complete tears were seen.

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