2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


The Highlight Elbow Lateral Pathology with Ultrasound Test to Unveil Elbow Minor Instability

Paolo Angelo Arrigoni, MD, Milan ITALY
Aurelien Traverso, MD, Lausanne SWITZERLAND
Valeria Vismara, MD, Milan ITALY
Simone Cassin, MD, Milan ITALY
Andrea Zagarella, MD, Milano ITALY
Pietro S. Randelli, MD, Prof., Milan ITALY

ASST Gaetano Pini CTO, Milan, Milan, ITALY

FDA Status Not Applicable

Summary

HELP US test

Abstract

Background

Recent evidences suggest that the extra-articular/tendon-related source could be not the sole cause of lateral elbow pain, but part of a multifactorial process, involving intra-articular causes and factors. Arthroscopy is regarded as the gold standard for identifying intra-articular findings in such cases, with flexion arthro-CT being considered its closest alternative. Therefore, diagnosis of minor elbow instability is often delayed by several months, if not years, waiting for conservative measures to assess the problem. A timely diagnosis could help achieve better patient care. While ultrasound (US) stress tests have been instrumental in evaluating joint instability across various anatomical sites, their role in diagnosing minor instability of the lateral elbow remains unexplored. The purpose of this study is to evaluate whether there is lateral joint opening in a functional position with dynamic varus-stressed ultrasound (ultrasound instability) in cases of clinical suspects of atraumatic minor instability.

Materials And Methods

Patients with suspects of minor instability were compared to a control group of non-pathologic elbows. Eligible patients underwent varus stress ultrasound of the elbow with 70° of flexion of the elbow and a 3 kg weight fixed to the wrist. The presence of lateral widening and its increase were documented and compared between the groups. The test was named Highlight Elbow Lateral Pathology with UltraSound (HELP US).

Results

Sixty-five elbows were evaluated in this study. Thirty-five patients were cases (80% male, mean age 47 years), and 30 healthy controls (77% male, mean age 49 years). The mean lateral elbow joint width was 26,7% in the pathological group, meanwhile, in the control arm, the mean lateral elbow joint width increase was 3,2%. The groups had a significant difference in the widening of the lateral elbow during the HELP US test (p<0.01). Within the cases, a total of 17 patients (48%) had a history of previous corticosteroid injections. The mean lateral elbow joint width increase was 27%, showing no difference with those patients who showed no history of previous corticosteroid injections.

Conclusions

The HELP US test can detect changes in the lateral elbow compartment and can depict lateral elbow articular space widening. This is a valid diagnostic tool and should be implemented in evaluating all patients complaining of lateral elbow pain. The HELP US test could help physicians screen for a timely diagnosis of minor instability and speed up the request for second-level imaging studies to those patients that effectively require it the most.