Ultrasound-Guided Procedures in Common Tendinopathies at the Elbow: From Image to Needle

Ultrasound is presented as an essential tool for diagnosis and precise needle guidance in common elbow tendinopathies: tennis elbow, golfer’s elbow, distal biceps, and distal triceps tendinopathy. It allows real-time evaluation of tendon structure, detects changes such as thickening, hypoechogenicity, calcifications, tears, and hypervascularity, and helps guide injections or needling while avoiding nearby nerves and vessels. This is especially useful at the elbow, where anatomy is complex and physical examination may be nonspecific.

Interesting highlights:

• Real-time ultrasound guidance improves procedural precision and helps avoid vulnerable structures such as the radial nerve, ulnar nerve, brachial artery, and median nerve.

• In tennis elbow, ultrasound can show tendon degeneration and guide peri- or intratendinous treatment depending on the target.

• In golfer’s elbow, ultrasound is important not only for the tendon itself, but also for distinguishing associated medial collateral ligament injury or nearby ulnar nerve problems.

• For distal biceps tendon procedures, the “cobra position” is highlighted as a practical way to access the tendon footprint more safely.

• The review also notes that clinical examination alone is often incomplete, so ultrasound can help reach the final diagnosis and choose the correct intervention.

Who is this article most useful for?
PM&R physicians, sports medicine clinicians, radiologists, MSK sonographers, and trainees managing elbow pain and ultrasound-guided tendon procedures.