title: Validity of musculoskeletal ultrasound for identification of humeroradial joint chondral lesions: a preliminary investigation.
abstract: BACKGROUND
  Epicondylalgia is a common condition involving pain-generating structures such as tendon, neural, and chondral tissue. The current noninvasive reference standard for identifying chondral lesions is magnetic resonance imaging. Musculoskeletal ultrasound (MUS) may be an inexpensive and effective alternative.
  
  
  OBJECTIVE
  To determine the intrarater reliability and validity of MUS for identifying humeroradial joint (HRJ) chondral lesions.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Clinical anatomy research laboratory.
  
  
  METHODS
  Twenty-eight embalmed cadavers (14 women, 14 men; mean age = 79.5 ± 8.5 years).
  
  
  METHODS
  An athletic trainer performed MUS evaluation of each anterior and distal-posterior capitellum and radial head to identify chondral lesions. The reference standard was identification of chondral lesions by gross macroscopic examination. Intrarater reliability for reproducing an image was calculated using the intraclass correlation coefficient (3,k) for measurements of the articular surface using 2 images. Intrarater reliability to evaluate a single image was calculated using the Cohen κ for agreement as to the presence of chondral lesions. Validity was calculated using the agreement of MUS images and gross macroscopic examination.
  
  
  RESULTS
  Intrarater reliability was 0.88 (95% confidence interval = 0.77, 0.94) for reproducing an image and 0.93 (95% confidence interval = 0.80, 1.06) for evaluating a single image. Identifying chondral lesions on all HRJ surfaces with MUS demonstrated sensitivity = 0.93, specificity = 0.28, positive predictive value = 0.58, negative predictive value = 0.77, positive likelihood ratio = 1.28, and negative likelihood ratio = 0.27.
  
  
  CONCLUSIONS
  Musculoskeletal ultrasound is a reliable and sensitive tool for a clinician with relatively little experience and training to rule out HRJ chondral lesions. These results may assist with clinical assessment and decision making in patients with lateral epicondylalgia to rule out HRJ chondral lesions.
authors.affiliation: Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock.
authors.forename: Chelsea M
authors.initials: CM
authors.lastname: Lohman
authors.forename: Michael P
authors.initials: MP
authors.lastname: Smith
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Dedrick
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Brismée
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002102:Cadaver; D002357:Cartilage Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D014463:Ultrasonography