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Ahead of print publication
A needle in a haystack

1 Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada
2 Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Korea

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Date of Submission16-Apr-2020
Date of Decision28-Apr-2020
Date of Acceptance07-May-2020
Date of Web Publication27-Jun-2020

How to cite this URL:
Mares C, Chang MC, Boudier-Reveret M. A needle in a haystack. J Med Ultrasound [Epub ahead of print] [cited 2021 Apr 17]. Available from: http://www.jmuonline.org/preprintarticle.asp?id=288210

  Section 1 – Quiz Top


A 58-year-old, right-handed, female was seen in the outpatient clinic of our local university teaching hospital's physical medicine and rehabilitation department for the left lateral elbow pain evolving over the last year.

She was being followed for depression, rheumatoid arthritis, and was known for cervical spinal stenosis with a small zone of myelomalacia. Her medication included pregabalin, prednisone, and clopidogrel.

She described mechanical pain over her left lateral epicondyle. On observation, there was no swelling, deformities, or scars. Physical examination revealed a positive Mills and Cozen sign. There was no ROM limitation. She had pain on palpation over her left lateral epicondyle.

A diagnostic ultrasound using a high-resolution linear multifrequency (7–18Hz) probe on a Toshiba Aplio 500 ultrasound machine and a standardized elbow scanning protocol[1] revealed signs of tendinosis of the common extensor tendon without radial collateral ligament tears and absence of elbow effusion. While scanning the brachialis muscle in transverse axis at the distal arm level, the image was obtained [Figure 1]. Can you find the needle in the haystack?
Figure 1: On this transverse view of the ventral arm, approximately 3 cm proximal to the elbow joint, please localize and describe the anomaly

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Özçakar L1, Kara M, Chang KV, Hung CY, Tekın L, Ulaşlı AM, et al. EURO-MUSCULUS/USPRM basic scanning protocols for elbow. Eur J Phys Rehabil Med 2015;51:485-9.  Back to cited text no. 1

Correspondence Address:
Mathieu Boudier-Reveret,
Hôtel-dieu Du Centre Hospitalier De L'université De Montréal, 3840, Saint-urbain St., Montreal, QC, H2w 1T8
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Source of Support: None, Conflict of Interest: None


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