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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Singer AD, Hanna T, Jose J, Datir A. A systematic, multimodality approach to emergency elbow imaging. [Review]. Clin Imaging. 40(1):13-22, 2016 Jan-Feb. Review/Other-Dx N/A To review the elbow anatomy and provide a comprehensive presentation of elbow injuries that are commonly seen in the emergency department accompanied by multimodality imaging findings. No results stated in abstract. 4
2. Pierce JL, Perry MT, Wessell DE, et al. ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol 2022;19:S473-S87. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). No results stated in abstract. 4
3. Thomas JM, Chang EY, Ha AS, et al. ACR Appropriateness Criteria® Chronic Elbow Pain. J Am Coll Radiol 2022;19:S256-S65. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic elbow pain. No results stated in abstract. 4
4. Schnetzke M, Aytac S, Studier-Fischer S, Grutzner PA, Guehring T. Initial joint stability affects the outcome after conservative treatment of simple elbow dislocations: a retrospective study. J. ORTHOP. SURG.. 10:128, 2015 Aug 20. Observational-Dx 68 patients To identify patients with deteriorated outcome after conservative treatment and to investigate a possible association with initial joint (in)stability. After 40.7 ± 20.4 months, the overall MEPS was excellent (94.2 ± 11.3) with a trend of slightly worse clinical results in group 2 (95.8 ± 9.0 vs. 90.0 ± 15.2 points; p = 0.154). In group 1, significantly more patients achieved an excellent result regarding the MEPS scoring system (77.6 vs. 52.6 %; p = 0.043) and elbow extension was significantly worse in group 2 (5.3 ± 9.9° vs. 1.4 ± 3.0°; p = 0.015). Seven treatment complications occurred in group 2 (36.8 %) compared with two in group 1 (4.1 %, p < 0.0001). Six patients (8.8 %) needed secondary surgery with an 8.4-fold higher risk for revision surgery in group 2 (p = 0.007). The presence of a positive drop sign or joint incongruence led to higher odds ratio (OR) for complications (OR = 15.9) and revision surgery (OR = 10.3). 2
5. Schnetzke M, Bergmann M, Wegmann K, et al. Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model: A Cadaveric Study. J Bone Joint Surg Am. 100(7):564-571, 2018 Apr 04. Observational-Dx Twelve elbow specimens To analyze, under fluoroscopy, joint angulation of uninjured elbows and elbows with distinct induced collateral ligament injury. Testing of the intact elbow specimen by both examiners showed a joint angulation of <5°. Transection of the LUCL led to a varus joint angulation of 4.3° to 7.0°, and transection of the AML resulted in a valgus joint angulation of 4.9° to 8.8°. Complete dissection of the respective collateral ligament complex resulted in a joint angulation of 7.9° to 13.4° (LCLC) and 9.1° to 12.3° (MCL), and additional transection of the AC led to a joint angulation of >20° in some positions in both the medial and the lateral series. Under varus stress, elbow dislocations occurred only after dissection of the LCLC+AC (26% of the examinations) and additional dissection of the MCL (59%). Under valgus stress, elbow dislocations occurred only after dissection of the MCL+AC (30%) and additional dissection of the LCLC (47%). Very good to excellent ICCs were found among Examiners 1 and 2 and the tests done with the standardized torques at stages 1 through 4. 3
6. Acar K, Aksay E, Oray D, Imamoglu T, Gunay E. Utility of Computed Tomography in Elbow Trauma Patients with Normal X-Ray Study and Positive Elbow Extension Test. J Emerg Med. 50(3):444-8, 2016 Mar. Observational-Dx 110 patients To assess trauma patients, using computed tomography (CT), who present with a positive elbow extension test and have no evident fracture on x-ray study. One hundred and forty-eight patients presented to our emergency department with elbow trauma. Two patients were excluded from the study, one with former motion disability and another with an open fracture. In the remaining patients, there were 32 fractures in total. Forty-three of 114 patients without fracture signs had a positive elbow extension test and 4 of these patients refused CT imaging. Fractures were found in 5 (12.8%) of the 39 patients assessed with CT. CT imaging found that two of these patients had a radial head fracture, two others had an olecranon fracture, and one patient had a coronoid fracture. 3
7. Lee SH, Nam DJ, Yu HK, Kim JW. The lateral ligament is injured preferentially in posterolateral dislocation of the elbow joint. Bone Joint J. 102-B(2):227-231, 2020 Feb. Review/Other-Dx 64 patients To evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. A total of 54 patients had a fracture; some had more than one. Radial head fractures were found in 25 patients and coronoid fractures in 42. Lateral and medial humeral epicondylar fractures were found in eight and six patients, respectively. Contusion of the capitellum was found in 43 patients and rupture of the LCL was seen in all patients (partial in eight and complete in 56), there was complete rupture of the MCL in 37 patients, partial rupture in 19 and eight had no evidence of rupture. The LCL tear did not significantly correlate with the presence of fracture, but the MCL rupture was complete in patients with a radial head fracture (p = 0.047) and there was significantly increased association in those without a coronoid fracture (p = 0.015). 4
8. Lubberts B, Janssen S, Mellema J, Ring D. Quantitative 3-dimensional computed tomography analysis of olecranon fractures. J Shoulder Elbow Surg. 25(5):831-6, 2016 May. Review/Other-Dx 78 patients To further clarify fracture morphology between Mayo type I, II, and III fractures. Displaced olecranon fractures were more comminuted than nondisplaced fractures (P = .02). Displaced fractures without ulnohumeral subluxation were smallest in terms of both volume (P < .001) and articular surface involvement (P < .001) of the most proximal olecranon fracture fragment. There was no difference in average displacement of the proximal fragment between displaced fractures with and without ulnohumeral subluxation (P = .74). Anterior olecranon fracture-dislocations created more displaced (P = .04) and smaller proximal fragments than posterior fracture-dislocations (P = .005), with comparable fragmentation on average (P = .60). 4
9. Al-Ani Z, Tham JL, Ooi MWX, Wright A, Ricks M, Watts AC. The radiological findings in complex elbow fracture-dislocation injuries. [Review]. Skeletal Radiol. 51(5):891-904, 2022 May. Review/Other-Dx N/A To outline the management principles in complex elbow fracture-dislocation injuries and describe radiological findings. No results stated in abstract. 4
10. Pavic R, Margetic P, Hnatesen D. Diagnosis of occult radial head and neck fracture in adults. Injury. 46 Suppl 6:S119-24, 2015 Nov. Observational-Dx 193 patients To compare imaging modalities in the diagnosis of occult radial head and neck fractures and to assess the diagnostic value of ultrasound in diagnosing occult fractures of the radial head and neck. In all 193 cases, ultrasound examination showed intraarticular effusion. In 176 cases (91%), there was effusion in both the olecranon bursa and the elbow joint. In 10 patients (5%), there was effusion only inside the elbow joint and in seven cases (4%) there was effusion only in the olecranon bursa. Cortical discontinuity (a direct sign of fracture) was clearly visualised in 157 cases (82%), in the radial neck in 108 cases and in the radial head in 49 cases. Ultrasound findings of fracture were questionable in 36 cases (18%). Step-off deformities, tiny avulsed bone fragments, double-line appearance of cortical margins, and diffuse irregularity of the bone surfaces were identified as auxiliary ultrasound findings (indirect signs of fracture). Standard radiograms were repeated after 7-10 days. In 184 cases (95%), there was a clearly visible fracture: a fracture of the radial neck in 111 cases (58%) and a fracture of non-displaced radial head in 73 cases (37%). In nine cases (5%), radial fracture was not confirmed on radiogram and MRI was performed in these patients. 3
11. Avci M, Kozaci N, Beydilli I, Yilmaz F, Eden AO, Turhan S. The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries. Am J Emerg Med. 34(11):2186-2190, 2016 Nov. Observational-Dx 49 patients To compare the efficacy of point-of-care ultrasound (POCUS) and computed tomography (CT) in the diagnosis of the fracture of the bones that form the elbow joint and the determination of treatment method in elbow injuries. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery. 2
12. Barret H, Gastaud O, Laumonerie P, et al. Feasibility and technique of ultrasound traumatic elbow lesion assessment. Orthop Traumatol Surg Res. 107(2):102836, 2021 04. Observational-Dx 9 patients To describe the technique of ultrasound traumatic elbow lesion assessment performed by an orthopedic surgeon. Four radial head osteochondral fractures were detected on ultrasound in addition to the 4 fractures seen on radiography, without significant difference (p=0.071). Clinical examination found 2 cases of valgus laxity and 5 of varus laxity. Ultrasound, performed blind to radiography, found 1 medial collateral ligament anterior bundle lesion (in 1 of the 2 patients with valgus laxity) and 4 lateral collateral ligament ulnar bundle lesions (in 4 of the 5 patients with varus laxity). There were no epicondylar or epitrochlear tendon lesions. Scanning time decreased significantly over the study period, from a mean 30minutes in the first 5 cases to a mean 24.8minutes in the last 5 (p=0.046). Three patients could not be put in the cobra position, and 3 showed poor echogenicity. 3
13. Bucknor MD, Stevens KJ, Steinbach LS. Elbow Imaging in Sport: Sports Imaging Series. [Review]. Radiology. 279(1):12-28, 2016 Apr. Review/Other-Dx N/A To discuss how CT, MR imaging, or US can be used to evaluate different pathologic conditions within the elbow No results stated in abstract. 4
14. Abehsera E, Guerre E, Duriez P, El Rafei M, Fontaine C, Chantelot C. Ligaments injuries check-up and assessment of their healing potential in simple posterolateral elbow dislocation: about 25 cases. Eur. j. orthop. surg. traumatol.. 29(4):785-792, 2019 May. Review/Other-Dx 25 patients To list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2 months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up. 4
15. Dutto E, Artiaco S, Gallo A, Borre A, Sard A, Battiston B. MRI in acute simple elbow dislocations: correlation of preoperative imaging and intraoperative findings of collateral ligaments and associated soft tissue injuries. Musculoskelet Surg. 106(2):127-132, 2022 Jun. Observational-Dx 59 patients To evaluate the correspondence among collateral ligaments and other soft tissue injuries detected by MRI and by intraoperative findings in a consecutive series of patients treated for simple elbow dislocation. MRI showed full-thickness lesion of MCL in 9/16 patients (53.3%) and partial lesion in 6/16 patients (40%), and in 1 case, the MCL was considered intact. On the lateral side, MRI showed complete injury of LCL in 7/16 patients (46.6%) and partial injury in 7/16 patients (40%). No lesions of LCL were observed in 2 patients (13.4%). MCL was surgically explored in all the patients. We observed 10/16 full-thickness lesions (62.5%) and 6/16 partial lesions (37.5%). LCL was surgically explored in 11/16 patients. We observed 6/11 full-thickness lesions (54.6%) and 5/11 partial lesions (45.4%). In 3 cases, associated soft tissue injuries were detected. The rate of concordance between MRI and surgical findings was 87.5% (14/16 cases) on the medial side and 90.9% (10/11 cases) on the lateral side. 3
16. Luokkala T, Temperley D, Basu S, Karjalainen TV, Watts AC. Analysis of magnetic resonance imaging-confirmed soft tissue injury pattern in simple elbow dislocations. J Shoulder Elbow Surg. 28(2):341-348, 2019 Feb. Observational-Dx 17 consecutive cases of simple elbow dislocations. To describe the injured structures observed in magnetic resonance images (MRIs) in a prospective cohort of simple elbow dislocations. The initial radiographs in 16 patients showed the dislocation was posterolateral in 12, posterior in 3, and posteromedial in 1. We observed complete AC tear in 12 patients, MCL in 10, and LCL in 9. The inter-rater reliability for the radiologists was 0.70 (substantial) for MRI. 4
17. Schnetzke M, Schuler S, Hoffend J, et al. Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation. BMC Musculoskelet Disord. 18(1):85, 2017 02 20. Observational-Dx 30 patients To assess the interobserver and intraobserver agreement on ligamentous injuries on conventional magnetic resonance imaging (MRI) in acute simple elbow dislocation. Interobserver agreement of all examiners was fair to moderate for collateral ligaments (LCL: 0.441, MCL: 0.275). Exact agreement of all raters was found in 33.3% for the LCL and in 26.7% for the MCL. The both experienced examiners showed highest agreement strength for the LCL (0.619) and the radiologists showed highest agreement strength for the MCL (0.627), the proportion of exact agreement was 60.0% in both categories. A high proportion of exact agreement regarding joint congruity (90%), joint effusion (100%), loose bodies (96.7%) and chondral lesion (80%) was found among the radiologists. The evaluation of the intraobserver agreement revealed slight to substantial agreement (0.227 to 0.718) for the collateral ligaments. 3
18. Tarallo L, Merolla G, Porcellini G, et al. Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury. Int Orthop. 45(1):265-273, 2021 01. Observational-Dx 32 patients To assess elbow ligament tears after dislocation using magnetic resonance imaging (MRI) and to correlate any pre-operative imaging with intra-operative findings of elbow ligament tears. Inter-rater agreement for MRI evaluation of 32 was poor for lateral ulnar collateral ligament (LUCL) tears, fair for radial collateral ligament (RCL), moderate for annular ligament (AL), and fair for ulnar collateral ligament (UCL). All tears were reported as complete by rater 1; 13/32 partial tears were identified by rater 2 (LUCL = 2, RCL = 2, UCL = 9). Correlation between surgical and MRI findings showed good inter-rater agreement for LUCL and AL tears in both raters. Agreement for RCL tear was poor for rater 1 and fair for rater 2; agreement for UCL tear was fair for rater 1 and poor for rater 2. Intra-operative findings showed ten radial head fractures (RHFs) and ten coronoid fractures (CFs). LUCL tears were found in the four cases of type II RHFs and in 3/4 cases of CFs. 2
19. Demino C, Fowler JR. Magnetic Resonance Imaging Findings After Elbow Dislocation: A Descriptive Study. Hand. 17(4):730-733, 2022 07. Review/Other-Dx 12 patients To retrospectively analyze and describe the patterns of ligamentous, tendinous, and muscular injuries in patients with an acute elbow dislocation and subsequent magnetic resonance image (MRI) evaluation. Magnetic resonance imaging findings included the following: UCL was injured in 11 of 12 patients; RCL was injured in 9 of 12 patients; LUCL was injured in 9 of 12 patients; common flexor tendon was injured in 11 of 12 patients; and common extensor tendon was injured in 9 of 12 elbows. The biceps, brachialis, and triceps tendons showed injury in 1 of 12, 2 of 12, and 2 of 12 elbows, respectively. Four elbows had at least 1 fracture present, whereas 8 demonstrated an effusion. 4
20. Alizai H, Engebretsen L, Jarraya M, Roemer FW, Guermazi A. Elbow Injuries Detected on Magnetic Resonance Imaging in Athletes Participating in the Rio de Janeiro 2016 Summer Olympic Games. J Comput Assist Tomogr. 43(6):981-985, 2019 Nov/Dec. Review/Other-Dx 15 athletes To describe the frequency, anatomic distribution, and severity of magnetic resonance imaging (MRI)-detected elbow joint injuries among athletes who competed in the Rio de Janeiro 2016 Summer Olympics. Ligamentous injuries were most common, with injuries of the ulnar collateral ligament being the most prevalent (n = 12; 80%), followed by the common flexor tendon (n = 8; 53%). Osseous injuries were far less common (n = 3; 20%), with no acute fractures seen. Weightlifting (n = 4; 27%) and judo (n = 4; 27%) athletes were most commonly affected. 4
21. Draghi F, Bortolotto C, Ferrozzi G. Distal Biceps Brachii Tendon Insertion: A Simple Method of Ultrasound Evaluation. J Ultrasound Med. 40(4):811-813, 2021 Apr. Review/Other-Dx N/A To describe a new method of ultrasound evaluation of the distal biceps tendon insertion with the patient in the so-called crab position. The crab position is used to evaluate the posterior compartment of the elbow but also the lateral and medial compartments. This position allows for coverage of 75% the elbow in a single position, with less discomfort for the patient and a fair amount of saved time. In this position, after the evaluation of the common extensor tendon in the long axis, turning the transducer 90° and moving it distally allows for optimal visualization of the distal biceps brachii tendon in the axial plane. 4
22. Fitzpatrick D, Menashe L. Magnetic Resonance Imaging Evaluation of the Distal Biceps Tendon. Am J Orthop. 47(5), 2018 May. Review/Other-Dx N/A 4
23. Lee JH, Ahn KB, Kwon KR, Kim KC, Rhyou IH. Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clin Orthop. 479(4):781-789, 2021 Apr 01. Review/Other-Dx 22 patients To describe the associated injury and injury mechanisms involved in a traumatic distal triceps tendon rupture In the indirect injury group (fall on an outstretched hand), 15 of 15 patients had injuries that involved only the tendinous portion of the distal triceps, but these injuries were not full-thickness tears, whereas in the direct injury group, three of seven patients had a full-thickness rupture (odds ratio [OR] 1.75 [95% CI 0.92 to 3.32]; p = 0.02). The direct injury group had no associated ligamentous injuries while 14 of 15 patients with indirect injuries had ligamentous injuries (OR 0.13 [95% CI 0.02 to 0.78]; p < 0.001; associated injuries in the indirect group: anterior medial collateral ligament [14 of 15], posterior medial collateral ligament [7 of 15], and lateral collateral ligament complex [2 of 15]). Similarly, one of seven patients in the direct injury group had a bone injury (capitellar contusion), whereas 15 of 15 patients with indirect ruptures had associated fractures or bone contusions (OR 16.0 [95% CI 2.4 to 106.7]; p < 0.001). 4
24. Nicolay RW, Lawton CD, Selley RS, et al. Partial rupture of the distal biceps brachii tendon: a magnetic resonance imaging analysis. J Shoulder Elbow Surg. 29(9):1859-1868, 2020 Sep. Observational-Dx 77 patients The partial ruptures were caused by a traumatic mechanism in 57.1% of cases, 23.4% were atraumatic, and 19.5% had an unknown mechanism. The most common injury morphology was a partial LH rupture with an intact SH tendon (33.8%). Isolated complete ruptures of the LH represented the least common injury morphology. Injury morphology was significantly related to mechanism (P < .01). Traumatic ruptures had a higher percentage of SH involvement compared with the atraumatic group (77.3% vs. 37.7%, respectively). In contrast, atraumatic ruptures involved the LH tendon in 89% of cases, with only 37.7% of cases involving the SH tendon. Patients with a history of smoking were more likely to have an atraumatic mechanism (P = .01). A history of diabetes was unrelated to mechanism (P = .20). 2
25. Giuffre BM, Moss MJ. Optimal positioning for MRI of the distal biceps brachii tendon: flexed abducted supinated view. AJR Am J Roentgenol. 182(4):944-6, 2004 Apr. Observational-Dx 21 patients To describe a novel way of positioning the patient with the shoulder abducted, elbow flexed, and forearm supinated. Three cases among 22 elbows in the study group exhibited normal distal biceps brachii tendons; in 14 cases, evidence of a partial tear or tendinosis of the distal biceps brachii tendon was present; in four cases, a complete tear was present; and in one case, an intact repaired complete tear was seen. In all cases, the full length of the biceps brachii tendon from musculotendinous junction to insertion on the radial tuberosity could be shown in one or, at most, two sections. In the 13 cases in which sagittal series were also performed, a single section less commonly showed the full tendon in one or two sections. In four of these six asymptomatic volunteer evaluations, the flexed abducted supinated view showed the complete length of the tendon in one section; in the other two cases, it was seen in two sections. In the sagittal series of the healthy volunteers, the full tendon was seen in one section in only two cases. 3
26. Schenkels E, Caekebeke P, Swinnen L, Peeters J, van Riet R. Is the flexion-abduction-supination magnetic resonance imaging view more accurate than standard magnetic resonance imaging in detecting distal biceps pathology?. J Shoulder Elbow Surg. 29(12):2654-2660, 2020 Dec. Observational-Dx 50 patients with surgically confirmed distal biceps tendon pathology and 50 patients with other elbow disorders. To evaluate the accuracy of the FABS view MRI in the diagnosis of distal biceps tendon pathology. There were no significant differences in sensitivity and specificity in detecting partial distal biceps injuries when the FABS view MRI (sensitivity, 84%; specificity, 86%) and standard MRI (sensitivity, 76%; specificity, 98%) were compared. The interobserver reliability was 92% for the FABS view MRI with biceps pathology and 68% for standard MRI. In the control group, the interobserver reliability was 88% for the FABS view MRI and 96% for standard MRI. FABS MRI was significantly better regarding grade of injury. 2
27. Tiegs-Heiden CA, Frick MA, Johnson MP, Collins MS. Utility of the FABS MRI sequence in the evaluation of distal biceps pathology. Skeletal Radiol. 50(5):895-902, 2021 May. Observational-Dx 46 elbow MRIs To evaluate whether obtaining additional MR imaging in the FABS position changes the radiologist's assessment of the distal biceps tendon compared with traditional sequences only. Pooled intra rater reliability was 0.800 (0.714, 0.886) between the -F and +F groups. Pooled mean confidence was 7.163 (1.252) for the -F group and 8.370 (1.264) for the +F group (p < 0.001). Pooled diagnostic accuracy was 0.651 (0.420, 0.882) for the -F group and 0.615 (0.456, 0.875) for the +F group compared with the surgical reference standard. 2
28. Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J. ORTHOP. SURG.. 26(2):2309499018778364, 2018 May-Aug. Observational-Dx 8 patients To define the accuracy of MRI in differentiating partial- from full-thickness tear of the distal triceps tendon. Of the three surgically confirmed complete tears, MRI correctly reported a complete tear in all patients. Of the six partial tears confirmed at surgery, MRI correctly identified four tears. In two cases, MRI described a complete tear, but only a partial tear was noted at surgery. 3
29. Al-Ani Z, Lauder J. Ultrasound assessment in distal biceps tendon injuries: Techniques, pearls and pitfalls. [Review]. Clin Imaging. 75:46-54, 2021 Jul. Review/Other-Dx N/A To describe the various ultrasound approaches used to assess the distal biceps tendon with their advantages and limitations. No results stated in abstract. 4
30. de la Fuente J, Blasi M, Martinez S, et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol. 47(4):519-532, 2018 Apr. Observational-Dx 120 patients To analyze ultrasound findings in patients with distal biceps brachii tendon (DBBT) injuries to assess the sensitivity of ultrasound in detecting the different forms of injury, and to compare ultrasound results with magnetic resonance imaging (MRI) and surgical results. For major DBBT injuries (complete tears and high-grade partial tears), the concordance study between exploration methods and surgical results found that ultrasound presented a slight statistically significant advantage over MRI (ultrasound: ? = 0.95-very good-95% CI 0.88 to 1.01, MRI: ? = 0.63-good-95% CI 0.42 to 0.84, kappa difference p < 0.01). Minor injuries, in which most tendon fibres remain intact (tendinopathies, elongations and low-grade partial tears), are the most difficult to interpret, as ultrasound and MRI reports disagreed in 12 out of 39 cases and no surgical confirmation could be obtained. 3
31. Lynch J, Yu CC, Chen C, Muh S. Magnetic resonance imaging versus ultrasound in diagnosis of distal biceps tendon avulsion. Orthop Traumatol Surg Res. 105(5):861-866, 2019 09. Observational-Dx 31 patients To determine the efficiency of MRI and ultrasonography US in the diagnosis of DBT rupture confirmed by operative findings. The accuracy of MRI and US was 86.4% and 45.5% in diagnosis of complete DBT rupture, respectively. Accuracy rate of MRI (66.7%) was the same as US in diagnosis of partial tear. Overall accuracy rate of MRI (80.6%) was higher than US (51.6%) in diagnosis all DBT avulsion with an odds ratio of 3.9. Sensitivity and specificity of MRI were 76.0% and 50.0%, while that of ultrasonography were 62.5% and 20.0%. 3
32. Deschrijver M, Hautekiet A, Steyaert A, De Muynck M, Luypaert E. Distal biceps tendon ruptures: more efficient diagnostics for a better outcome. Acta Orthop Belg. 88(1):160-167, 2022 Mar. Review/Other-Dx N/A To determine the most efficient use of diagnostics for the assessment of distal biceps tendon ruptures. No results stated in abstract. 4
33. Miller TT, Konin GP, Nguyen JT, et al. Ultrasound of the distal biceps brachii tendon using four approaches: reproducibility and reader preference. Skeletal Radiol 2021;50:937-43. Observational-Dx 50 healthy elbows To determine which sonographic appearance of the distal biceps brachii tendon (DBBT) is preferred by readers, and if images obtained by two different operators are reproducible. The medial approach was preferred in 79.6% of elbows, anterior in 17.6%, lateral in 2.8%, and the posterior approach was never preferred. The difference was statistically significant (P < 0.001). Kappa values for the five readers were 0.61 to 0.8 for choosing the images produced by the medial approach. 2
34. Downey R, Jacobson JA, Fessell DP, Tran N, Morag Y, Kim SM. Sonography of partial-thickness tears of the distal triceps brachii tendon. J Ultrasound Med. 30(10):1351-6, 2011 Oct. Review/Other-Dx 5 patients To retrospectively characterize the sonographic appearance of partial-thickness distal triceps brachii tendon tears. Five patients had a partial-thickness distal triceps brachii tendon tear at surgery (n = 4) or magnetic resonance imaging (n = 1). All cases only involved the superficial tendon layer (combined long and lateral heads) with retraction of a fractured olecranon enthesophyte fragment. The deep tendon layer (medial head) was intact in all cases with no joint effusion. 4
35. Tagliafico A, Gandolfo N, Michaud J, Perez MM, Palmieri F, Martinoli C. Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol. 81(6):1207-10, 2012 Jun. Review/Other-Dx 8 patients To describe the role of US in distal triceps tendon tears evaluation. N = 4 complete tears of the triceps tendon and n = 4 partial tears of the distal triceps involving the lateral/superficial head were identified. Patients with partial tear had a history of a single traumatic event that determined a sudden eccentric contraction of the triceps muscle against resistance. US demonstrated on axial and longitudinal planes a partial tear of the triceps brachii tendon that resulted in a fusiform swelling and retraction of the lateral/superficial head in four patients. It was possible to identify the normal insertion of the medial head of the triceps moving the transducer medially. MR and surgical findings were concordant with US findings in every patient. 4
36. Dixit A, Dandu N, Hadley CJ, Nazarian LN, Cohen SB, Ciccotti M. Ultrasonographic Technique, Appearance, and Diagnostic Accuracy for Common Elbow Sports Injuries. [Review]. JBJS rev.. 8(11):e19.00219, 2020 11. Review/Other-Dx N/A To review the utility and indications for the use of ultrasonography for common elbow injuries in athletes. No results stated in abstract. 4
37. Park JY, Kim H, Lee JH, et al. Valgus stress ultrasound for medial ulnar collateral ligament injuries in athletes: is ultrasound alone enough for diagnosis?. J Shoulder Elbow Surg. 29(3):578-586, 2020 Mar. Observational-Dx 146 athletes To determine if valgus stress ultrasound would be useful for both identifying medial ulnar collateral ligament (MUCL) tears and assessing the severity of the tears. A higher degree of MUCL injury on MRI was associated with greater joint gapping in the medial elbow on stress ultrasound. At 30° of elbow flexion, the cutoff value for complete MUCL rupture was 0.5 mm (P < .001), with a sensitivity and specificity of 88.1% and 61.5%, respectively. At 90° of elbow flexion, the cutoff value for complete MUCL rupture was 1.0 mm (P < .001), with a sensitivity and specificity of 81.0% and 66.4%, respectively. 2
38. Zaremski JL, Vincent KR, Vincent HK. Elbow Ulnar Collateral Ligament: Injury, Treatment Options, and Recovery in Overhead Throwing Athletes. Curr Sports Med Rep 2019;18:338-45. Review/Other-Tx N/A To review the basic anatomy, risk factors for UCL injury in overhead throwing athletes, treatment approaches, and future directions for prevention and treatment of injury based on the evidence-based data in the peer-reviewed literature. No results stated in abstract. 4
39. van Duijn AJ, Felton SD. Ultrasound Imaging of Ulnar Collateral Ligament Injury. J Orthop Sports Phys Ther. 46(12):1086, 2016 Dec. Review/Other-Dx 1 patient 4
40. Bilger R, Laumonerie P, Barret H, et al. Ultrasonography: an interesting imaging method for ligament assessment during the acute phase of closed elbow injuries. J Med Ultrason (2001). 49(4):739-746, 2022 Oct. Observational-Dx 40 patients 2
41. Arrigoni P, Cucchi D, Luceri F, et al. Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament. Knee Surg Sports Traumatol Arthrosc. 29(12):4067-4074, 2021 Dec. Observational-Dx 9 cadaveric specimens To evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. The release of the anterior half of the CEO significantly increased ? by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in ?. 3
42. Bachta A, Rowicki K, Kisiel B, et al. Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis. PLoS ONE. 12(7):e0181828, 2017. Observational-Dx 58 patients To investigate the diagnostic performance and reliability of ultrasonography (US) in detecting and grading common extensor tendon (CET) tear in patients with chronic lateral epicondylitis (LE), using magnetic resonance imaging (MRI) as the reference standard. US showed moderate agreement with MRI in detecting and grading CET tear (? = 0.49). Sensitivity, specificity, and accuracy in CET tear detecting by US were 64.52%, 85.19%, and 72.73%, respectively. PPV and NPV of US were 83.33% and 67.65%, respectively. No patient with unconfirmed CET tear on US had high-grade CET tear on MRI. 2
43. Park G, Kwon D, Park J. Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy. Chin Med J. 127(17):3110-5, 2014. Observational-Dx 28 patients To investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy. Both the imaging methods had high sensitivity, specificity, and accuracy for diagnosing lateral elbow tendinopathy. Considering the clinical diagnosis of lateral elbow tendinopathy, sonoelastography showed significantly higher diagnostic accuracy (96.4%) than ultrasonography (89.5%, P < 0.01). Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows (P < 0.01). 3
44. Campbell RE, McGhee AN, Freedman KB, Tjoumakaris FP. Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review. Am J Sports Med. 48(11):2819-2827, 2020 09. Review/Other-Dx 15 articles 4
45. Sutterer BJ, Boettcher BJ, Payne JM, Camp CL, Sellon JL. The Role of Ultrasound in the Evaluation of Elbow Medial Ulnar Collateral Ligament Injuries in Throwing Athletes. [Review]. Curr Rev Musculoskelet Med. 15(6):535-546, 2022 Dec. Review/Other-Dx N/A 4
46. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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