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I wonder what findings in an MRI may influence the treatment in case of an elbow tendinopathy. I have noticed that a fair amount of physicians (at least in the United States and in France) are reluctant to order MRIs, so I wonder whether it is due to the cost of an MRI, or its usefulness to decide the treatment.

For example, http://radsource.us/lateral-epicondylitis/ says:

MRI can establish the extent of tendon injury and assess for a coexisting radial collateral ligament injury (4a), which may hinder the patient’s response to conservative therapy. In addition, the lack of expected MRI changes in a patient with suspected lateral epicondylitis suggests radial nerve entrapment, which may mimic or coexist with lateral epicondylitis.

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I think it is mainly due to the evidence indicating poor accuracy (sensitivity and specificity) of conventional MRI. It means that false-positive or false-negative findings may be detected in MRI of elbow (1):

MR arthrography is more accurate than conventional MRI of the elbow at 3 T.

  • [In 54 out of 79 patients, the diagnoses made on MRI and MR arthrogram examinations were the same.]
  • In 16 [out of 79] cases, MR arthrography showed tendons and ligaments to be torn that appeared intact on conventional MRI.
  • In 9 [out of 79] cases, MR arthrography showed intact tendons and ligaments that appeared to be torn on conventional MRI. These nine cases are most likely the result of the tears healing, with fibrous tissue allowing the tendon and ligament tissues to coapt (1).

Hence, due to these common misleading results of MRI, physicians weigh more on their own physical examination and clinical judgement.

Do not forget that high-quality evidence (e.g., systematic reviews or meta-analysis based on randomized clinical trials) for this subject has not yet collected or reported; which makes this debate controversial.

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    Thank you, very interesting study! 30% (=25/79) is a fair amount of discrepancy indeed. I would be very interested to compare MR arthrography + MRI vs. directly looking at the tendon (e.g., cadaver examination). – Franck Dernoncourt Mar 23 '19 at 19:20

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