The Role of the Extensor Digitorum Communis Muscle in Lateral Epicondylitis

2002 ◽  
Vol 27 (5) ◽  
pp. 405-409 ◽  
Author(s):  
S. M. FAIRBANK ◽  
R. J. CORLETT
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Middle Finger ◽  
Clinical Findings ◽  
Extensor Digitorum ◽  
Common Finding ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
High Prevalence ◽  
Pain Ratings

A common finding in tennis elbow is pain in the region of the lateral epicondyle during resisted extension of the middle finger (Maudsley’s test). We hypothesized that the pain is due to disease in the extensor digitorum communis muscle, rather than to compression of the radial nerve or disease within extensor carpi radialis brevis. Thirteen human forearm specimens were examined. It was found that the extensor digitorum communis was separable into four parts. The part to the middle finger originated from the lateral epicondyle, but the muscle slips to the other fingers originated more distally. Pain ratings were measured in ten patients diagnosed with lateral epicondylitis during isometric finger and wrist extension tests. The results confirmed the high prevalence of a positive Maudsley’s test in lateral epicondylitis, and also that the patients with tenderness at the site of origin of the extensor digitorum communis slip to the middle finger had the greatest pain during middle finger extension. These anatomical and clinical findings clarify the anatomy of extensor digitorum communis, and suggest that this muscle forms the basis for the Maudsley’s test. The muscle may play a greater role in tennis elbow than previously appreciated.

scholarly journals Extensor Carpi Radialis brevis: Review of Anatomy and Clinical Significance to Orthopedics

2019 ◽  
Vol 2 (1) ◽  
pp. 01-08
Author(s):  
Jennifer L Smith ◽  
Jacob B Stirton ◽  
Nabil A Ebraheim
Keyword(s):  
Clinical Significance ◽  
Radial Nerve ◽  
Lateral Epicondylitis ◽  
Extensor Digitorum ◽  
Surgical Approaches ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
The Third ◽  
Proper Management ◽  
Extensor Carpi Radialis

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.

Perineural injection as an alternative treatment of resistant lateral elbow pain

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanaa Ahmed Hany Abd Eldayem Ahmed El-Naggar ◽  
Mona Mansour Mohammed Hasab El-Naby ◽  
Naglaa Youssef Mohammed Assaf ◽  
Mohja Ahmed Abd El-Fattah Elbadawy
Keyword(s):  
Clinical Improvement ◽  
Tennis Elbow ◽  
Functional Limitations ◽  
Lateral Epicondylitis ◽  
Elbow Pain ◽  
Lateral Epicondyle ◽  
Lateral Elbow Pain ◽  
Perineural Injection ◽  
Lateral Elbow ◽  
Tendon Thickness

Abstract Background Lateral elbow pain (LEP) or lateral epicondylitis (LE) is a common problem affecting both males and females. Multiple therapeutic modalities are used with different outcomes. Objective The current study aimed at description of the effectiveness of a newly introduced modality, Perineural Injection (PNI) therapy in comparison to the already used therapeutic ultrasound (TUS) as a conventional modality in the treatment of resistant LEP (LE). Patients and methods This is a longitudinal interventional study. Thirty patients of both sexes aged between 21 to 62 years old who had LE were randomly allocated into two groups (15 each). In PNI group, 5% buffered dextrose was injected subcutaneously around the lateral epicondyle once weekly for 8 weeks. In TUS group, continuous US was used 3 sessions per week for 4 weeks. Tenderness grading scale, visual analogue scale (VAS), Patient- Rated Tennis Elbow Evaluation Questionnaire (PRTEE) score, and ultrasonographic evaluation were used before and 12 weeks after treatment. Results In both groups, there was a high significant clinical improvement at 12th week after treatment. However, the improvement was better in the PNI group than the TUS group. By US evaluation at 12th week after treatment, there was a significant decrease in hypoechoic areas and disturbed fibrillar pattern in PNI group compared to before therapy (p < 0.001 and = 0.025) respectively. But in TUS group, there was decrease in hypoechoic areas and tendon thickness compared to before treatment (p = 0.02 and 0.026) respectively. Conclusion Both PNI and TUS therapies for LE gave clinical improvement for pain, functional limitations and some ultrasonographic findings (as echogenity, fibrillar pattern and tendon thickness). However, PNI therapy gave better outcome as compared to TUS.

Lateral Epicondylitis: A Common Cause of Elbow Pain in Primary Care

2021 ◽  
pp. 34-38
Author(s):  
Jeffrey Fleming ◽  
Christian Muller Muller ◽  
Kathryn Lambert Lambert
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Tennis Elbow ◽  
Imaging Modality ◽  
Treatment Options ◽  
Lateral Epicondylitis ◽  
Repetitive Motion ◽  
Lateral Epicondyle ◽  
Magnetic Resonance Imaging Mri ◽  
Standard Radiographs

Lateral epicondylitis (LE) is an overuse injury of the lateral elbow. LE is caused by repetitive motion leading to micro-injury of the wrist extensor muscles that originate along the elbow's lateral aspect. Although LE is commonly referred to as “tennis elbow” many cases are observed in non-athletes. Due to its prevalence in the general population, primary care physicians must be prepared to diagnose and treat LE. Physicians should look for a history of repetitive activities involving patient’s jobs or recreational activities. Exam findings are characterized by pain and tenderness just distal to the lateral epicondyle of the humerus. Resisted movement with an extension of the wrist will typically elicit pain. Ultrasonography is considered the imaging modality of choice for diagnosing LE. Standard radiographs and magnetic resonance imaging (MRI) may be helpful. However, diagnosis can usually be made by history and physical examination alone. Most cases of LE respond favorably to conservative therapy. There are several nonoperative options for treatment, but a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy that utilizes eccentric muscle stretching is considered first-line. Osteopathic manipulative medicine is also useful in the treatment of LE. Muscle energy (ME) and joint mobilization techniques have been shown to be particularly effective. If non-surgical therapy fails, surgical intervention may provide patients with an additional benefit. This article will review some of the treatment options described above and discuss other diagnostic and therapeutic considerations relevant to LE's management in the primary care setting.

ANATOMIC AND CLINICAL STUDY OF A NEUROVASCULAR CAUSE OF LATERAL EPICONDYLITIS

2009 ◽  
Vol 12 (01) ◽  
pp. 11-19
Author(s):  
Xin-Ru Du ◽  
Ling-Xiu Zhao
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Triceps Brachii ◽  
Tissue Samples ◽  
Lateral Epicondyle ◽  
The Common ◽  
Pass Through ◽  
The Right ◽  
Neurovascular Bundles

Because of few anatomic reports investigating the mechanism of lateral epicondylitis (tennis elbow), we performed cadaveric and clinical studies to investigate the involvement of neurovascular bundles passing through the common extensor origin. We dissected and observed under a light microscope tissue samples of neurovascular bundles passing through the common extensor tendon from 40 upper left and right limbs from cadavers. Tissue samples were prepared by hematoxylin & eosin and Weil's myelin staining. We also investigated the records of 20 patients who had been treated for lateral epicondylitis between 1991 and 2004. From cadavers, we found 60 bundles in the common extensor tendon, each 0.5 to 1.0 mm in diameter, with more bundles in the right than left limbs. Twenty-four of these bundles passed over the vertex of the lateral epicondyle of the humerus, and most of the bundles contained only one artery each. The bundles mostly originated from the radial recurrent artery, passing through the aponeurosis of the extensor corpi radialis brevis, but in some cases originated from the radial collateral artery, passing through the aponeurosis of the triceps brachii muscle. The bundles had a membranous covering when passing through the aponeurosis and produced a hiatus. Histological analysis of resected common extensor tendon tissue, 1 cm in diameter, of patients showed hyaline degeneration and fibrosis formation infiltration. Neurovascular bundles passed through the common extensor tendon in nine cases; six cases showed pulsing bleeding. After a mean follow-up of two years (6–48 months), 16 cases showed excellent results, two showed good results and two showed reliefs. Lateral epicondylitis could be caused by damage to neurovascular bundles when they pass through the common extensor origin; one cause of pain is the neurovascular bundle being compressed when passing through the common extensor tendon, secondary to the pathologic degeneration of the origin of the common extensor tendon.

Anatomic Basis for Individuated Surface EMG and Homogeneous Electrostimulation With Neuroprostheses of the Extensor Digitorum Communis

2008 ◽  
Vol 100 (1) ◽  
pp. 64-75 ◽  
Author(s):  
J.N.A.L. Leijnse ◽  
S. Carter ◽  
A. Gupta ◽  
S. McCabe
Keyword(s):  
Ring Finger ◽  
Surface Emg ◽  
Extensor Digitorum ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
Fine Wire ◽  
Anatomic Basis ◽  
The Individual ◽  
Emg Electrodes ◽  
Little Finger

The extensor digitorum communis (ED) is generally regarded as a fairly undiversified muscle that gives extensor tendons to all fingers. Some fine wire electromyographic (EMG) investigations have been carried out to study individuation of the muscle parts to the different fingers. However, individuated surface EMG of the ED has not been investigated. This study analyses the anatomy of the ED muscle parts to the different fingers in detail and proposes optimal locations for surface or indwelling electrodes for individuated EMG and for electrostimulation with neuroprostheses. The dissections show that the ED arises from extensive origin tendons (OT), which originate at the lateral epicondyle and reach far in the forearm. The ED OT is V-shaped with shorter central tendon fibers but with a long radial and an even longer ulnar slip. The ED parts to the individual fingers consistently arise from distinct OT locations: the ED3 (medius) arises proximally, the ED2 (index) from the radial slip distal to ED3, the ED4 (ring finger) from the ulnar slip distal to ED3, and the ED5 (to ring/little finger) from the ulnar slip distal to ED4. This lengthwise widely spaced arrangement of ED parts compensates to some degree for the narrow ED width and suggests that ED parts should be individually assessable by indwelling and even by surface EMG electrodes, albeit in the latter case with variable mutual cross-talk. Conversely, the anatomic spacing of ED parts warrants that electromyographic stimulation with neuroprostheses by a single implanted electrode cannot likely homogeneously activate all ED parts.

scholarly journals A Comparative study to evaluate the efficacy of Supervised Exercise Program and Cyriax Physiotherapy on pain and function in Lateral Epicondylitis

2021 ◽  
Author(s):  
Gouri Kalaskar ◽  
R. K. Sinha ◽  
Pratik Phansopkar
Keyword(s):  
Tennis Elbow ◽  
Exercise Program ◽  
Lateral Epicondylitis ◽  
Exercise Programme ◽  
Functional Improvement ◽  
Lateral Epicondyle ◽  
Supervised Exercise ◽  
Time Period ◽  
Elbow Function ◽  
And Function

Abstract Background: A typical musculotendinous degenerative condition of the extensors cause at the humerus lateral epicondyle is known as Lateral epicondylitis. Various treatment methods are used in treating lateral epicondylitis. Methods: Thirty Participants with Lateral Epicondylitis shall be recruited in a comparative experimental study. Subjects will be randomized to either (1) Supervised Exercise Programme group, or (2) Cyriax Physiotherapy group. Over a 4-week time period, a 3 times in week for the total of 12 sessions, immediately following baseline assessment and randomization, subjects in both groups will receive Extensor Carpi Radialis Brevis muscle’s static stretching along with the wrist extensor’s eccentric strengthening and Ultrasound and transverse deep friction massage for 10 min with Mill’s manipulation and Ultrasound respectively. Discussion: Effectiveness of the interventions on the pain and the functional improvement will be assessed by visual analogue scale and the Tennis Elbow Function Scale respectively.

The Role of Supinator in the Pathogenesis of Chronic Lateral Elbow Pain: A Biomechanical Study

2004 ◽  
Vol 29 (5) ◽  
pp. 461-464 ◽  
Author(s):  
S. ERAK ◽  
R. DAY ◽  
A. WANG
Keyword(s):  
Tensile Force ◽  
Balloon Catheter ◽  
Extensor Tendon ◽  
Biomechanical Study ◽  
Extensor Digitorum ◽  
Moderate Increase ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
The Common ◽  
Extensor Carpi Radialis

The relative contributions of the forearm extensors to the tensile force at the lateral epicondyle were examined by implanting a force transducer in the common extensor tendon of four soft fixed cadaver elbows and sequentially stretching each muscle arising from the lateral epicondye. Extensor carpi radialis brevis and extensor digitorum communis produced the largest increases while the superficial head of supinator produced a moderate increase in tensile force in the common extensor tendon. Extensor carpi radialis longus and extensor carpi ulnaris had no significant effect. Radial tunnel pressure was measured using a balloon catheter in a separate study of five cadaver elbows. Radial tunnel pressure increased on moving the wrist from neutral to a flexion–pronation position. This positional rise in pressure was reduced by supinator musculotendinous lengthening (77%) while lengthening of the extensor carpi radialis brevis and extensor digitorum communis had no effect. This study demonstrates a biomechanical basis for the superficial head of supinator in the aetiology of both lateral epicondylitis and radial tunnel syndrome.

Lateral epicondylitis: the condition and current management strategies

2019 ◽  
Vol 80 (11) ◽  
pp. 647-651 ◽  
Author(s):  
James Duncan ◽  
Robert Duncan ◽  
Saksham Bansal ◽  
Dominic Davenport ◽  
Andrew Hacker
Keyword(s):  
Clinical Practice ◽  
Secondary Care ◽  
Tennis Elbow ◽  
Management Strategies ◽  
Lateral Epicondylitis ◽  
Treatment Decisions ◽  
Current Clinical Practice ◽  
Common Condition ◽  
Current Management ◽  
High Prevalence

Lateral epicondylitis or tennis elbow is a common condition estimated to affect between 1 and 3% of adults. As a result of its high prevalence, both primary and secondary care physicians are frequently presented with this problem, so knowledge of its presentation and up-to-date management strategies is essential. This review collates the most recent evidence on lateral epicondylitis to help the clinician perform assessments and make treatment decisions, based on the best current clinical practice.

scholarly journals The three-portal technique in arthroscopic lateral epicondylitis release

2017 ◽  
Vol 8 (4) ◽  
Author(s):  
Ashok Gowda ◽  
Gannon Kennedy ◽  
Stacey Gallacher ◽  
Jennie Garver ◽  
Theodore Blaine
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Arthroscopic Technique ◽  
Lateral Epicondyle ◽  
Extensor Muscles ◽  
The Common ◽  
One Year ◽  
Extensor Carpi Radialis ◽  
Portal Technique ◽  
Lower Morbidity

Lateral epicondylitis, commonly referred to as tennis elbow, is a syndrome characterized by pain over the origin of the common extensor muscles of the fingers, hand and wrist at the lateral epicondyle. Reports of 70-90% response to conservative treatment at one year have been documented in the literature though refractory cases often require surgical management. Arthroscopic treatment of lateral epicondylitis allows for intra-articular visualization for concomitant pathology and localization of the Extensor Carpi Radialis Brevis tendon. Additionally, compared to the open technique, the arthroscopic technique has a lower morbidity and an earlier return to work and activity. Here we describe a three portal technique for improved visualization in arthroscopic lateral epicondylitis release.

scholarly journals COMPARATIVE STUDY REGARDING THE BENEFITS OF USING MEDICAL FLOSSING IN LATERAL EPICONDYLITIS

2021 ◽  
Author(s):  
Diana VRABIE ◽  
Beatrice-Aurelia ABALAȘEI ◽  
George-Sebastian IACOB
Keyword(s):  
Pain Intensity ◽  
Tennis Elbow ◽  
Intervention Group ◽  
Lateral Epicondylitis ◽  
Rehabilitation Program ◽  
Initial Assessment ◽  
Functional Score ◽  
Control Group ◽  
Jump Performance ◽  
Lateral Epicondyle

Although there are multiple published reviews about the effects of the most common techniques, such as stretching or the use of foam roller on the range of motion (Behm et al., 2016; Wilke et al., 2020) or performance parameters (Behm & Wilke, 2019; Konrad et al., 2021), there is no analysis on the effects of medical flossing. To date, two reviews have been publishedabout effectiveness of using ankle flossing to improve dorsiflexion amplitude or jump performance (Pisz et al., 2020; Kielur & Powden, 2020). This study aimed to investigate the effectiveness of medical flossing added to routine treatment in patients with epicondylitis, compared to conventional physiotherapy treatment. The study included 6 subjects who showed localized pain in the area of the lateral epicondyle exacerbated with the Cozen test. The other criteria for selecting patients were the duration of the symptoms, less than 3 months from the onset of the disease and pain intensity more than 5 on the Visual Analog scale.To monitor the evolution of the subjects involved, we used a visual analog pain scale to assess the intensity of pain at different times during the application of therapy, before and after the end of the treatment. Another tool used to measure the degree of pain and dysfunction was the PRTEE Questionnaire (Patient-Rated Tennis Elbow Evaluation). The rehabilitation program took place between August and September 2021, for 30 days, with afrequency of 3 times per week. 6 patients with lateral epicondylitis were included and medical flossing was used only in the case of 3 patients at each therapy session. The differences between groups at the time of the initial assessment, in terms of pain intensity were statistically insignificant (p=0.288, p>0.05). The results obtained in terms of decreasing pain were in favor of the use of medical flossing as an adjuvant method in specific pain existing in lateral epicondylitis. Although in both groups there was a decrease in pain after 4 weeks of treatment, the intervention group recorded significant reduced values compared to the control group (p=0.024; p<0.05). Regarding PRTEE Functional Score, at the final assesment there was a decrease in both groups, which means the functional condition of the patients has improved.

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