Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis (original) (raw)
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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.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
Purpose: To determine whether the radial component of the lateral collateral ligament (R-LCL) and extensor carpi radialis brevis (ECRB) are consistently visible, using a 70 arthroscope, as parallel structures in the extra-articular space of the elbow, and to evaluate the clinical outcomes of these techniques in a series of patients. Methods: An arthroscopic ECRB tendon release was performed between 2008 and 2010. Eighteen patients were retrospectively evaluated at a minimum of 24 months' follow-up. The surgeon performed the ECRB release while protecting the R-LCL and viewing the structures extra-articularly with a 70 arthroscope through the anteromedial portal. Patients underwent surgery if they presented with localized tenderness and pain not responding to conservative treatment for 12 months and had magnetic resonance imaging scans indicating tendinopathy or degeneration. Arthritis, posterolateral rotatory instability, trauma, and previous surgeries were exclusion criteria. Intraoperative videos were reviewed and a clinical examination was performed by an independent reviewer at 24 months postoperatively. Patients were also evaluated with the Mayo Elbow Performance Score; Andrews-Carson score; and shortened Disabilities of the Arm, Shoulder and Hand questionnaire. Direct varus stress was applied in extension and flexion (40 ), and the posterolateral pivot-shift and chair tests were performed. Results: Visualization with the 70 arthroscope through the anteromedial portal was successful in all of the cases (100%). Visualization of the residual ECRB tendon stump, as well as the posterior common extensor tendon, was also achieved 94% of the time. The final mean Mayo Elbow Performance Score and Andrews-Carson score were 82.5 (range, 60 to 100) and 185.3 (range, 125 to 200), respectively. The mean postoperative score on the shortened Disabilities of the Arm, Shoulder and Hand questionnaire was 20.14 (range, 5 to 57.5). Clinical tests showed stability in all the cases. Conclusions: The 70 arthroscope allows visualization of the ECRB insertion and R-LCL frontally and in parallel. A surgical plane could be created between the structures. The clinical outcome was good or excellent in 78% of the cases. Level of Evidence: Level IV, therapeutic case series.
The Journal of Hand Surgery, 2014
Purpose To identify the unique anatomical characteristic of the extensor carpi radialis brevis (ECRB) origin and points of differentiation from other extensors and to clarify the specific relationship of the ECRB to the underlying structures. Methods We studied the origin of each extensor macroscopically for its muscular and tendinous parts; to identify the relationship between the ECRB origin and the deeper structures, we also examined the attachment of the joint capsule under the ECRB origin. Results The ECRB simply originated as a tendon without any muscle, whereas other extensors originated as a mixture of tendon and muscle. At the anterior part of the ECRB origin, the thin attachment of the joint capsule (average width, 3.3 mm) lay deep to the ECRB and was distinct. However, at the posterodistal portion, the joint capsule, annular ligament, and supinator were intermingled and originated as a single wide sheet from the humerus (average width, 10.7 mm). Conclusions The anterior part of the ECRB origin was delicate, because the ECRB origin was purely tendinous, and the attachment of the articular capsule was thin compared with that of the posterodistal attachment. This thin attachment could be an initial factor leading to the development of lateral epicondylitis. Clinical relevance The results of the current study may enhance magnetic resonance imaging understanding and may help clarify the etiology of the lateral epicondylitis.
Egyptian Journal of Orthopedic Research, 2021
The purpose of this study was to evaluate results of the release of extensor carpi radialis brevis (ECRB) in tennis elbow patients. A prospective study including twenty patients with resistant chronic lateral epicondylitis was carried out in the period between June 2018 and June 2019 at Sohag University Hospital. These 20 patients underwent arthroscopic ECRB release. Evaluation of the pain and function included visual analog scale (VAS), Quickdash score, and Nirschl staging score preoperatively, postoperatively, two weeks, four weeks, ten weeks, and six months postoperatively. The patients showed highly statistically and clinically significant differences in the form of clinical improvement indicated by the level of Quickdash, VAS, and Nirschl staging scores at each time interval of the patients follow up. There was minimal postoperative pain, early rehabilitation, and early return to activity could be achieved. Arthroscopic release of the ECRB is an effective method of treatment in patients with resistant tennis elbow.
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.
Surgical treatment of tennis elbow: percutaneous release of the common extensor origin
Acta orthopaedica Belgica, 2004
Twenty six patients who had undergone percutaneous release of the common extensor tendon for lateral epicondylitis were investigated. Fourteen were female and twelve were male. The mean follow-up period was 32 months. Symptoms had been present for an average of 8.9 months. Before the surgery, all the patients were surgically treated with conservative methods; only those that did not respond to conservative methods were surgically treated. The common extensor origin was released percutaneously. Pain relief was achieved on average eight weeks after surgery. The clinical results were evaluated in terms of pain, activity level and patient satisfaction. The results were excellent in twenty-four patients, good in one and poor in one. Release of the common extensor origin appears as a commendable treatment in patients with lateral epicondylar pain not relieved by conservative management.
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.
Anatomy & Physiology, 2013
Aim: This study aimed to address the lack of detailed information on the fascia, and the potentially diverse attachments of the Extensor Carpi Radialis Brevis and Extensor Digitroum Communis on the lateral epicondyle. Methodology: Twenty cadavers were dissected by layers consisting of the skin, subcutaneous fat, superficial fascia, deep fascia, and muscles. Results/Conclusion: The separable attachment of the Extensor Capri Radialis Brevis and Extensor Digitorum Communis on the lateral epicondyle is best described as the Common Extensor Origin. This Common Extensor Origin is formed by the Extensor Digitorum Communis at its superficial portion (approximately 65-75% of the Common Extensor Origin thickness) and by the Extensor Carpi Radialis Brevis at its deepest quarter (approximately 25-35% of the Common Extensor Origin thickness). Distal to the radiocapitellar joint, the proximal bellies of the Extensor Carpi Radialis Brevis and Extensor Digitorum Communis appear tightly attached to the deep fascia. The attachments of lateral intermuscular septum and superficial fascia in the lateral elbow appear to be tight. Clinical relevance: Cadaveric findings on the location of the Extensor Carpi Radialis Brevis and Extensor Digitorum Communis at the lateral elbow may potentially guide the sonologists during diagnostic scan and surgeons during operation in localizing pathological changes within the Common Extensor Origin in the elbow.