Tennis elbow predominantly affects the extensor carpi radialis brevis tendon
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Peer-reviewed literature attributes tennis elbow (lateral epicondylitis) primarily to the degeneration and pathology of the extensor carpi radialis brevis tendon.
PURPOSE
Different arthroscopic techniques exist for managing the exterior carpi radials brevis (ECRB) when treating refractory lateral epicondylitis. The purpose of this study is to compare the outcomes of a standard arthroscopic débridement with ECRB tendon release to an arthroscopic ECRB tenotomy distal to its insertion without débridement using a retrospective cohort study design.
METHODS
This study included patients underwent arthroscopic treatment of lateral epicondylitis during 2 different time periods: 2016 to 2019 (débridement) and 2019 to 2021 (modified tenotomy without débridement). Patients were assessed preoperatively and at the last follow-up with mayo elbow performance score (MEPS), disabilities of the arm, shoulder and hand (DASH) score, visual analog scale (VAS) of pain.
RESULTS
A total of 69 patients completed the follow-up (38 in the débridement group and 31 in the tenotomy group). Patients in both groups showed significant improvements were found in MEPS, DASH, and VAS after surgery. Patients in the tenotomy group had higher MEPSs and reported less pain with a minimum 2 year follow-up after surgery. DASH scores between groups were similar at all time periods.
CONCLUSION
Arthroscopic modified tenotomy of the ECRB without débridement improves function and pain significantly for patients with refractory lateral epicondylitis, which is not inferior to arthroscopic débridement technique.
Lateral epicondylitis. A review of structures associated with tennis elbow. 139 limbs from embalmed specimens were dissected to reveal the attachments of extensor muscles in the vicinity of the lateral epicondyle. M. extensor carpi radialis brevis was found to consist of a keel-shaped tendon with attachments to m. extensor carpi radialis longus, m. extensor digitorum communis, m. supinator; and to the radial collateral ligament, the orbicular ligament, the capsule of the elbow joint and the deep fascia. On 29 limbs, a prolongation of the muscle was identified attaching proximal to the lateral epicondyle. On nine specimens a bursa was evident between the capsule over the head of the radius and the overlying soft tissues. There was no evidence of variation in vascular or nerve supply to the region. Examination of m. extensor carpi radialis brevis while under tension across the elbow, forearm and wrist revealed the greatest muscle lengthening in pronation of the forearm with palmar flexion and ulnar deviation. The results of this study support the hypothesis that tennis elbow is primarily a mechanically-induced condition.
Abstract Lateral epicondylitis, or tennis elbow, has been attributed to the degeneration of the extensor carpi radialis brevis tendon, with surgery reserved for recalcitrant cases. Surgical intervention of lateral epicondylitis includes release alone or release with repair. Outcomes of open surgical repair have been reported with better preservation of the grip strength than release alone. We describe a technique for the release and repair of the extensor carpi radialis brevis tendon using an arthroscopic approach, which could be used to repair the extensor carpi radialis brevis with minimal invasion and to address the concomitant intra‐articular pathology. Technique Video video See video under supplementary data.
Tennis elbow: an ultrasonographic study in tennis players. The findings of ultrasound examination at and around the lateral humeral epicondyle in 41 tennis players suffering from so called tennis elbow are reported. Ultrasound examinations were performed with a real time ultrasound machine. The tenderness and functional impairment of tennis elbow may be caused by several different lesions, at times appearing in association. Six ultrasonographic characteristics could be identified: Enthesiopathy The proximal part of the tendon was enlarged and there were echogenicity alterations. Tendonitis The tendon of the extensor carpi radialis brevis was enlarged and areas of dyshomogeneous hypoechogenicity were evident with loss of the normal microscopic waveform structure of the tendon collagen. Peritendonitis A thickening of the peritendonous lining was present. Bursitis A bursa was located on the inferior surface of the tendon of the extensor carpi radialis brevis. Intramuscular haematoma Some circular or ovoid hypoechogenic areas within the muscular substance of the extensor carpi radialis brevis were evident.
Tennis elbow. The surgical treatment of lateral epicondylitis.
Of the 1,213 clinical cases of lateral tennis elbow seen during the time period from December 19, 1971, to October 31, 1977, eighty-eight elbows in eighty-two patients had operative treatment. The lesion that was consistently identified at surgery was immature fibroblastic and vascular infiltration of the origin of the extensor carpi radialis brevis. A specific surgical technique was employed, including exposure of the extensor carpi radialis brevis, excision of the identified lesion, and repair. The results at follow-up were rated as excellent in sixty-six elbows, good in nine, fair in eleven, and failed in two. There was an over-all improvement rate of 97.7 per cent, and 85.2 per cent of the patients returned to full activity including rigorous sports.
Published in The Journal of bone and joint surgery. American volume (1979)
Tennis elbow (TE) is a relatively common painful condition affecting the upper extremity. The aetiology is not known, but TE is most often seen in middle aged individuals using repetitive and forceful gripping at work or recreational activities, and is referred to overuse injuries. The pathogenesis is not known, but there are so-called degenerative changes in the wrist- and finger-extensor muscle origin (common extensor origin - CEO). The pain mechanisms involved have not been scientifically clarified. The studies in the present thesis aimed to 1) evaluate the structure and blood flow using ul