Joint Capsule Attachment to the Extensor Carpi Radialis Brevis Origin: An Anatomical Study With Possible Implications Regarding the Etiology of Lateral Epicondylitis (original) (raw)
Related papers
Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis
Surgical and Radiologic Anatomy, 2010
Lateral epicondylitis (LE) or tennis elbow has been the subject of concern during the last 60 years, but the pathogenesis of the LE remains unclear. The LE can be due to the tendinogenic, articular or neurogenic reasons. Numerous theories have been put fourth in the recent past, out of which one of the most popular theories is that the condition results from repeated contraction of the wrist extensor muscles, especially the extensor carpi radialis brevis (ECRB) which may compress the posterior branch of the radial nerve (PBRN) at the elbow during pronation. We studied 72 upper limbs (36 formalin-fixed cadaver) for the origin, nerve supply and the course of PBRN in relation to the ECRB as one of the goal for the present study. The possible presence of an arch of the ECRB around the PBRN was also observed and recorded. The nerve to ECRB was a branch from the radial nerve in 11 cases (15.2%); from the PBRN in 36 cases (50%) and from the superficial branch of the radial nerve in 25 cases (34.7%), respectively. The ECRB had a tendinous arch in 21 cases (29.1%); a muscular arch in 8 (11.1%) cases and the arch was absent in 43 cases (59.7%). When the ECRB had a tendinous or muscular arch around the PBRN, it may compress the same and this condition may worsen during the repeated supination and pronation as observed in tennis and cricket players. The presence of such tendinous or muscular arch should be considered by orthopedicians and neurosurgeons, while releasing the PBRN during LE surgery.
The archives of bone and joint surgery, 2020
Background Lateral epicondylitis (LE) most commonly affects the Extensor Carpi Radialis Brevis (ECRB) tendon and patients are generally treated with injection therapy. For optimal positioning of the injection, as well as an estimation of the surface area and content of the ECRB tendon to determine the volume of the injectable needed, it is important to know the exact location of the ECRB in relation to the skin as well as the variation in tendon length and location. The aim of this study was to determine the variation in location and size of the ECRB tendon in patients with LE. Methods An observational sonographic evaluation of the ECRB tendon was performed in 40 patients with LE. The length of the ECRB tendon, distance from the cutis to the center of the ECRB tendon, the length of the osteotendinous junction at the epicondyle and the distance from cutis to middle of the osteotendinous junction were measured. Results The average tendon length was 1.68cm (range 1.27-1.98; SD 0.177). ...
Acta orthopaedica Belgica, 2013
Different surgical techniques exist to treat lateral epicondylitis. In most techniques, release of the common extensor origin is performed adjacent to the humeral epicondyle. The purpose of the present study was to assess the outcome of transverse sectioning of the intermuscular septum and the aponeuroses of the extensor carpi radialis brevis and extensor digitorum communis, 3 to 5 cm distally to the radial epicondyle. Forty-nine elbows were operated on in 44 patients. Subjective results were obtained after a mean followup of 33 months. Mean age of patients was 44 years. Mean disabilities of arm, shoulder and hand score was 6, mean visual analogue scale score for pain was 1 and for satisfaction 9. The result was excellent in 26, good in 15 and poor in 8 elbows following Spencer and Herndon. Mean absence from work was 40 days. We conclude that tendon release in the musculotendinous unit can be used to treat lateral epicondylitis.
Extensor Carpi Radialis brevis: Review of Anatomy and Clinical Significance to Orthopedics
Orthopaedics and surgical sports medicine, 2019
The extensor carpi radialis brevis (ECRB) muscle is an integral extensor and abductor of the wrist. It originates from the lateral epicondyle of the humerus, laying deep to the extensor carpi radialis longus and extensor digitorum communis, and superficial to the supinator. Insertion occurs at the base of the third metacarpal. The radial nerve or a derivative supplies innervation. Its significance in orthopedics is highlighted by its involvement in multiple surgical approaches, such as the Thompson and Kaplan approaches for exposure of the radius, as well as its association with several routinely observed pathologies. Many of the associated syndromes, such as lateral epicondylitis, arise from repetitive gripping motions or overuse and are frequently seen in the orthopedic clinic. This review seeks to provide a comprehensive summary of the relevance of the ECRB to the orthopedic setting to broaden knowledge of its anatomy and increase recognition and proper management of associated pathologies.
Annals of the Rheumatic Diseases, 2004
Objectives: To improve the understanding of epicondylitis by describing the normal structure and composition of the entheses associated with the medial and lateral epicondyles and their histopathology in elderly cadavers. Methods: Medial and lateral epicondyles were obtained from 12 cadavers. Six middle aged cadavers (mean 47 years) were used to assess the molecular composition of ''normal'' entheses from people within an age range vulnerable to epicondylitis. Cryosections of epicondylar entheses were immunolabelled with monoclonal antibodies against molecules associated with fibrocartilage and related tissues. A further six elderly cadavers (mean 84 years) were used for histology to assess features of entheses related to increasing age. Results: Tendon entheses on both epicondyles fused with those of the collateral ligaments and formed a more extensive structure than hitherto appreciated. Fibrocartilage (which labelled for type II collagen and aggrecan) was a constant feature of all entheses. Entheses from elderly subjects showed extensive microscopic damage, hitherto regarded as a hallmark of epicondylitis. Conclusions: Fibrocartilage is a normal feature and not always a sign of enthesopathy. Furthermore, pathological changes documented in patients with epicondylitis may also be seen in elderly people. The fusion of the common extensor and flexor tendon entheses with those of the collateral ligaments suggests that the latter may be implicated as well. This may explain why pain and tenderness in epicondylitis may extend locally beyond the tendon enthesis and why some patients are refractory to local treatments.
American Journal of Roentgenology, 2010
sites of tendons and ligaments along with their course allows more accurate demarcation of the structures around the lateral epicondyle. The goal of our study was to determine bone landmarks that help to identify the precise attachment sites of these structures and emphasize their course. Materials and Methods Analysis of Humeral Bones Thirty-three well-preserved humeri specimens selected at random were made available from the collection of a local museum. No records were available regarding sex, age, race, and cause of death. Two fellowship-trained musculoskeletal radiologists visually inspected the lateral epicondyle and lateral aspect of the distal portion of the humerus to identify recurrent osseous landmarks. One humerus was excluded because of previous damage to the lateral epicondyle. Discrete structures on the surface of the bone including prominences, ridges, crests, depressions, and flattened areas were recorded in the remaining 32 specimens. Their prevalence was calculated and their
Lateral Epicondylitis of the Elbow: US Findings
Radiology, 2005
PURPOSE: To determine the sensitivity and specificity of ultrasonography (US) in the detection of lateral epicondylitis and identify the US findings that are most strongly associated with symptoms. MATERIALS AND METHODS: Internal review board approval was obtained for retrospective review of the patient images, and the need for informed consent was waived. Internal review board approval was also obtained for scanning the 10 volunteers, all of whom gave informed consent. The study was compliant with the Health Insurance Portability and Accountability Act. US of the common extensor tendon was performed in 20 elbows in 10 asymptomatic volunteers (six men, four women; age range, 22-38 years; mean age, 29.6 years) and 37 elbows in 22 patients with symptoms of lateral epicondylitis (10 men, 12 women; age range, 30-59 years; mean age, 46 years). Fifty-seven representative images, one from each elbow, were randomly assorted and interpreted by three independent readers who rated each common extensor tendon as normal or abnormal. Abnormal images were further classified as demonstrating one or more of eight US findings. Readers interpreted each image at two separate sessions to determine intrareader variability. The authors calculated the sensitivity and specificity of US in the diagnosis of lateral epicondylitis and the odds ratio for each US finding. Odds ratios were considered statistically significant at P Ͻ .05 when 95% confidence intervals did not include one. RESULTS: Sensitivities of US in the detection of symptomatic lateral epicondylitis ranged from 72% to 88% and specificities from 36% to 48.5%. Odds ratios for the following findings were statistically significant (P Ͻ .05) for both reading sessions: calcification of common extensor tendon, tendon thickening, adjacent bone irregularity, focal hypoechoic regions, and diffuse heterogeneity. Odds ratios for lateral epicondyle enthesophytes were statistically significant (P Ͻ .05) for the first reading session only. Odds ratios for linear intrasubstance tears and peritendinous fluid were not statistically significant. CONCLUSION: US of the common extensor tendon had high sensitivity but low specificity in the detection of symptomatic lateral epicondylitis. The relationship between symptoms and intratendinous calcification, tendon thickening, adjacent bone irregularity, focal hypoechoic regions, and diffuse heterogeneity was statistically significant.
Indian Journal of Physiotherapy and Occupational Therapy - An International Journal, 2020
Introduction-Myofascial pain syndrome (MPS) is a myalgic condition in which muscle and musculotendinous pain are the primary symptoms. Some muscles are likely to develop Myofascial trigger points in cases of lateral epicondylitis and become possible cause of mainstay of symptoms. Hence the study was undertaken to find the prevalence of myofascial trigger points in such muscles. Methodology & Results-40 individuals aged between 20-50 years fulfilling the inclusion criteria were selected for the study with acute and chronic lateral epicondylitis. Brachioradialis, Biceps Brachii, Triceps Brachii, Supinator and Extensor carpi radialis brevis were checked for the presence of trigger point by palpation. Pressure algometer was used to check the pain threshold of each point. When the subject reports feeling pain the action of pressure is stopped and reading is recorded. Results showed a higher prevalence in females than males. The most prevalent area for trigger point was the brachioradialis followed by biceps brachii, extensor carpi radialis, triceps brachii and the least prevalent was the supinator. Conclusion-This study provides that the relation between myofascial trigger points in lateral epicondylitis is relatively high especially in Brachioradialis, It also shows that latent trigger points don't lead to severe functional disability.
Common extensor origin release in recalcitrant lateral epicondylitis - role justified?
2010
The aim of our study was to analyse the efficacy of operative management in recalcitrant lateral epicondylitis of elbow. Forty patients included in this study were referred by general practitioners with a diagnosis of tennis elbow to the orthopaedic department at a district general hospital over a five year period. All had two or more steroid injections at the tender spot, without permanent relief of pain. All subsequently underwent simple fasciotomy of the extensor origin. Of forty patients thirty five had improvement in pain and function, two had persistent symptoms and three did not perceive any improvement. Twenty five had excellent, ten had well, two had fair and three had poor outcomes (recurrent problem; pain at rest and night). Two patients underwent revision surgery. Majority of the patients had improvement in pain and function following operative treatment. In this study, an extensor fasciotomy was demonstrated to be an effective treatment for refractory chronic lateral epicondylitis; however, further studies are warranted.