Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review

Stefanos Karanasios; Vasileios Korakakis; Maria Moutzouri; Eleni Drakonaki; Klaudia Koci; Vasiliki Pantazopoulou; Elias Tsepis; George Gioftsos

doi:10.1016/j.jht.2021.02.002

Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review

J Hand Ther. 2022 Oct-Dec;35(4):541-551. doi: 10.1016/j.jht.2021.02.002. Epub 2021 Feb 27.

Authors

Stefanos Karanasios¹, Vasileios Korakakis², Maria Moutzouri³, Eleni Drakonaki⁴, Klaudia Koci³, Vasiliki Pantazopoulou³, Elias Tsepis⁵, George Gioftsos³

Affiliations

¹ Physiotherapy Department, University of West Attica, Egaleo, Greece. Electronic address: skaranasios@uniwa.gr.
² Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
³ Physiotherapy Department, University of West Attica, Egaleo, Greece.
⁴ Medical School of the European University Cyprus, Engomi, Nicosia Cyprus.
⁵ Physiotherapy Department, University of Patras, Greece.

PMID: 33814224
DOI: 10.1016/j.jht.2021.02.002

Abstract

Background: Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing.

Purpose: To review the diagnostic accuracy of examination tests used in LET.

Design: Systematic review following PRISMA-DTA guidelines.

Methods: We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET.

Results: Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%).

Conclusions: Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies.

Systematic review registration: PROSPERO ID CRD42020160402.

Keywords: Diagnosis; Sensitivity; Specificity; Tennis elbow.

Publication types

Systematic Review

MeSH terms

Elbow
Elbow Tendinopathy* / diagnosis
Humans
Magnetic Resonance Imaging
Musculoskeletal Diseases*
Sensitivity and Specificity
Tendinopathy* / diagnosis
Ultrasonography