Extensor Carpi Radialis Brevis Origin Research Articles

Ultrasonographic analysis of the extensor carpi radialis brevis in asymptomatic individuals

BackgroundTennis elbow is characteristically seen as damage at the extensor carpi radialis brevis (ECRB) on ultrasonography. In this study, damage at the origin of the ECRB was investigated using ultrasonography in elbows without complaints pertaining to the joint. MethodsWe investigated 282 elbows on the dominant side in volunteers who consented to participate in the study and had no complaints or history of trauma to either elbow, no tenderness in the lateral epicondylar region on physical examination, and no pain upon resisted extension of the wrist and/or middle finger with the elbow extended (162 men, 120 women; mean age 62 years, range 21–84 years). On ultrasonography, damage at the origin of the ECRB was defined as low echo or disruption in fiber orientation. Comparison between groups with and without damage was performed based on age, sex, history of sports activity involving the upper extremity, and history of work involving loading of the upper extremity. ResultsOf the 282 elbows, damage was noted in 60 (21.3%). Comparing the groups with and without damage, mean ages were 66.2 (40–80) years and 60.9 (21–84) years. The group with damage included 31 of 162 (18.1%) male elbows and 29 of 110 (26.4%) female elbows; 10 of 64 elbows (15.6%) had a positive history of sports involving the upper extremity and 50 of 218 elbows (22.9%) had no history; 16 of the 64 elbows (25.0%) had a positive history of work involving loading the upper extremity and 44 of the 218 elbows (20.2%) had no history. Age was significantly higher in the group with damage. The group with damage showed no significant differences in other categories. ConclusionsAsymptomatic damage at the ECRB origin was noted in 21.3% of elbows at higher ages, but there was no association with sports or work.

The Prevalence of Calcifications at the Origin of the Extensor Carpi Radialis Brevis Increases with Age.

Enthesopathy of the extensor carpi radialis brevis origin [eECRB] is a common idiopathic, non-inflammatory disease of middle age that is characterized by excess glycosaminoglycan production and frequently associated with radiographic calcification of its origin. The purpose of our study was to assess the relationship of calcification of the ECRB and advancing age. We included 28,563 patients who received an elbow radiograph and assessed the relationship of calcifications of the ECRB identified on radiograph reports with patient age, sex, race, affected side, and ordering indication using multivariable logistic regression. Calcifications of the ECRB were independently associated with age (OR:1.04; P<0.001); radiographs ordered for atraumatic pain (OR2.6; P<0.001) or lateral epicondylitis (OR5.5; P<0.001); and Hispanic ethnicity (OR1.5; P<0.001) and less likely to be found at the left side (OR0.68; P<0.001). Similarly, incidental calcifications of the ECRB, those on radiographs not ordered for atraumatic pain or lateral epicondylitis, were independently associated with age (OR1.03; P<0.001) and Hispanic ethnicity (OR1.5; P<0.024) and less likely to be found on the left side (OR0.71; P<0.001). We observed that about nine percent of people have ECRB calcification by the time they are in their sixth decade of life and calcifications persist in the absence of symptoms which supports the idea that eECRB is a common, self-limited diagnosis of middle age.

Does use of the 70° arthroscope improve the outcomes of arthroscopic débridement for chronic recalcitrant tennis elbow?

The use of a 70° arthroscope has been reported to provide better visualization of the extensor carpi radialis brevis origin at the lateral epicondyle. We aimed to compare the surgical outcomes of arthroscopic débridement using an additional 70° arthroscope with those using a 30° arthroscope alone in the treatment of chronic recalcitrant tennis elbow. A total of 68 consecutive patients who received arthroscopic débridement for chronic recalcitrant tennis elbow were retrospectively reviewed. A 30° scope was used in 41 patients (mean age, 47 years; range, 26-61 years), whereas an additional 70° scope was used in 27 patients (mean age, 50 years; range, 34-61 years). Outcomes were assessed using a visual analogscalefor pain and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire at the preoperative visit and at 3 months, 6 months, and 12 or more months after surgery. Both groups showed significant and progressive improvements in visual analog scale pain scores and Quick Disabilities of the Arm, Shoulder and Hand scores at 3 months, 6 months, and final follow-up (P < .05). However, no significant differences were found between the groups at all time points of measurement regarding those outcome measures (P > .05). In addition, the proportions of patients with excellent outcomes and those with clinically meaningful improvements were comparable between the groups (P = .397 and P = .558, respectively). The use of an additional 70° arthroscope did not provide a significant improvement in the outcomes of arthroscopic débridement for chronic recalcitrant tennis elbow.

Immediate effect of kinesio taping on pain and grip strength in individuals with lateral epicondylitis

Background: Lateral epicondylitis (LE) of elbow, involves tendinitis of the extensor carpi radialis brevis(ECRB). LE is characterised by superficial or deep macroscopic and microscopic tears at the tendinous origin of ECRB. Rigid taping has been proved effective in alleviating pain, improving muscle function and restoring functional movement patterns. Kinesiology taping (KT) has roughly the same thickness as the epidermis and can be stretched between 30% and 40% of its resting length longitudinally. Since KT is more user friendly and it support functions by maintaining active range of motion and without the circulation being repressed as compared to rigid taping, there is a need to study the effect of KT on grip strength and pain in subjects with LE. Aims and Objectives: 1. To report the pain pressure threshold of subjects in experimental and control groups before and after application of KT. 2. To determine the grip strength of subjects in experimental and control groups before and after treatment using KT. 3. To compare the values of pain pressure threshold and grip strength between experimental and control groups. Materials and Methods: Subjects satisfying the inclusion criteria were taken for the study by convenience sampling. The subjects of both groups were then assessed for pain and grip strength prior to the application of tape using a pain-pressure algometer and hand-held dynamometer respectively. Subjects in the experimental group were then applied with KT using muscle and space correction technique and the control group received sham taping. The outcomes were then re-assessed immediately after taping. Results: From the results obtained it was seen that there was a statistically significant difference (P Conclusion: The findings of the study indicates that, there is a significant improvement in pain pressure threshold and grip strength after the immediate application of KT in the experimental group as compared to the control group.

Arthroscopic Versus Open Lateral Release for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Trial

The purpose of this randomized clinical trial was to determine whether quality of life and function, as measured using subjective questionnaires and clinical assessment, are different after open versus arthroscopic debridement of the pathologic extensor carpi radialis brevis origin in the treatment of lateral epicondylitis at 1year postoperatively. Patients older than 16years with a minimum of 6months of nonoperative management for lateral epicondylitis were recruited into thisprospective, single-blinded randomized clinical trial. Patients were randomized intraoperatively to undergo open or arthroscopic release. Scores on the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure; visual analog scale (VAS); and Patient-Rated Tennis Elbow Evaluation (PRTEE) were recorded preoperatively and 3, 6, and 12months postoperatively. Grip strength was assessed by an independent assessor. All patients followed the same physiotherapy regimen. Between 2002 and 2014, we randomized 37 patients to the open technique and 38 to the arthroscopic technique. Both groups improved significantly from preoperatively to 12months postoperatively (P < .001). There were no significant differences between the 2 groups when comparing the DASH score, VAS score, PRTEE score, or grip strength at any time point. The only significant difference between study groups was that the arthroscopic technique resulted in a longer surgery time: 34.0minutes (standard error of the mean, 2.9minutes) versus 22.5minutes (standard error of the mean, 1.3minutes) (P= .005). Comparing the open versus arthroscopic technique in the surgical management of lateral epicondylitis through a randomized clinical trial, we determined that there was no difference between the 2 operative modalities when examining the DASH score, VAS score, PRTEE score, grip strength, or complication rate at 12months postoperatively. A shorter operative time coupled with potentially less setup time may favor open release. Level II, lower-quality randomized trial.

Enthesopathy of the Extensor Carpi Radialis Brevis Origin: Effective Communication Strategies.

Enthesopathy of the extensor carpi radialis brevis origin, generally known as tennis elbow, is a common condition arising in middle-aged persons. The diagnosis is typically clear based on the patient interview and physical examination alone; therefore, imaging and other diagnostic tests are usually unnecessary. The natural history of the disorder is spontaneous resolution, but it can last for >1 year. The patient's attitude and circumstances, including stress, distress, and ineffective coping strategies, determine the intensity of the pain and the magnitude of the disability. Despite the best efforts of medical science, no treatments, invasive or noninvasive, have been proven to alter the natural history of the condition. Given the lack of disease-modifying treatments for enthesopathy of the extensor carpi radialis brevis origin, orthopaedic surgeons can benefit from learning effective communication strategies to help convey accurate information that is hopeful and enabling.

Incidental magnetic resonance imaging signal changes in the extensor carpi radialis brevis origin are more common with age

Patients with enthesopathy of the extensor carpi radialis brevis (ECRB) demonstrate signal changes on magnetic resonance imaging (MRI). It is likely that these MRI changes persist for many years or may be permanent, regardless of symptoms, and represent an estimation of disease prevalence. We tested the hypothesis that the prevalence of incidental signal changes in the ECRB origin increases with age. We searched MRI reports of 3374 patients who underwent an MRI scan, including the elbow, for signal changes in the ECRB origin. Medical records were reviewed for symptoms consistent with ECRB enthesopathy. Prevalences of incidental and symptomatic signal changes were calculated and stratified by age. We used multivariate logistic regression analysis to test whether age, sex, and race were independently associated with ECRB enthesopathy and calculated odds ratios. Signal changes in ECRB origin were identified on MRI scans of 369 of 3374 patients (11%) without a clinical suspicion of tennis elbow. The prevalence increased from 5.7% in patients aged between 18 and 30 years up to 16% in patients aged 71 years and older. Older age (odds ratio, 1.04; P <.001) was independently associated with the incidental finding of ECRB enthesopathy on elbow MRI scans. Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. Our findings support the concept that ECRB enthesopathy is a highly prevalent, self-limited process that seems to affect a minimum of 1 in approximately every 7 people.

Factors associated with operative treatment of enthesopathy of the extensor carpi radialis brevis origin

This study investigated the factors associated with variation in the rate of surgery for enthesopathy of the extensor carpi radialis brevis (eECRB). We used a large database from 3 academic hospitals including 5964 patients with the diagnosis of eECRB from 2001 to 2007. Of those, 244 patients (4%) had surgery for eECRB. We used the date of the first encounter as the date of diagnosis. We also recorded the date of the first cortisone injection and surgery for eECRB. We used Cox multivariable regression analysis to find factors associated with surgery. We considered the following explanatory factors: age, sex, race, diabetes, a diagnosis of major depression, a diagnosis of an anxiety disorder, hospital, provider (surgeon vs. nonsurgeon), corticosteroid injection, and the time from diagnosis to the first cortisone injection. The hazard ratio of having surgery was 12-times greater if the initial provider was an orthopedic surgeon rather a nonsurgeon and 1.7-times greater at 1 of the 2 hospitals. The rate of surgery varied substantially, ranging from 0% to 22%. Corticosteroid injection delayed the time to surgery but was ultimately associated with a higher rate of surgery. The majority (86%) of surgeries were done within 1 year of the first documented office visit. It seems likely that an emphasis on the preferences and values of the patient rather than the surgeon would decrease the variation in surgery rates for eECRB observed in this study. Methods for optimizing the influence of patient preferences and values on decision making (eg, decision aids) merit additional study.

Lateral Epicondylitis Injection Therapy: A Safety and Efficacy Analysis of Hyaluronate versus Corticosteroid Injections

Lateral epicondylitis or tennis elbow, is a common elbow malady the extensor carpi radialis brevis origin. It is commonly treated by local injections of steroids are often associated with severe side effects and limited long term efficacy. Recently, hyaluronate is being increasingly used for the treatment of different degenerative processes of joints and soft tissue. Hyaluronate significantly and dose-dependently inhibits cell proliferation and decreased the expression level of mRNA for adhesion-related pro-collagens and cytokines. It is possible that such hyaluronate injections might improve results of injection therapy in tennis elbow syndrome. We reviewed 157 patients with tennis elbow that were treated in general, orthopaedic and hand clinics between 2003 and 2011. All patients were followed for up to one year according to a standardized protocol. Patients with rheumatoid arthritis and other rheumatoid diseases, after fractures or avascular necrosis about elbow, radial tunnel syndrome, and moderate and severe osteoarthritis were excluded. Patients were divided into three groups: first group treated by corticosteroid injection, second group treated by combination corticosteroid and hyaluronate injection and third group treated by hyaluronate injections only. The Hyaluronate treated group was clearly superior to the steroid group in efficacy measures (VAS score and DASH score) as well as side effect frequency. The combination therapy group was similar efficacy-wise to hyaluronate but similar to the steroid group in the number of associated side effects. In conclusion it seems that hyaluronate injection therapy is superior to steroid therapy in lateral epicondylitis.

Joint Capsule Attachment to the Extensor Carpi Radialis Brevis Origin: An Anatomical Study With Possible Implications Regarding the Etiology of Lateral Epicondylitis

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. 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. 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). 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. The results of the current study may enhance magnetic resonance imaging understanding and may help clarify the etiology of the lateral epicondylitis.

Combined Common Extensor and Supinator Aponeurotomy for the Treatment of Lateral Epicondylitis

Pain at the lateral epicondyle and the extensor origin that is attributable to lateral epicondylitis can be successfully treated with a combined aponeurotomy of the supinator and the extensor muscles. This technique has been used at our institution for over 3 decades with good results. Aponeurotomy of the supinator decompresses the posterior interosseous nerve, whereas the extensor aponeurotomy relieves the stresses on the extensor carpi radialis brevis origin. We retrospectively reviewed a series of 56 patients clinically diagnosed with resistant lateral epicondylitis who underwent surgery by a single surgeon with our technique between 2002 and 2010. Patients experienced a subjective improvement in symptoms, visual analog pain score, and grip strength (Jamar II). Only 3% of patients experienced recurrence requiring further treatment.

Innervation pattern at the undersurface of the extensor carpi radialis brevis tendon in recalcitrant tennis elbow

PurposeWe investigated the general, sensory, and sympathetic innervation patterns at the undersurface of the extensor carpi radialis brevis (ECRB) origin in patients with recalcitrant tennis elbow. MethodsEight elbows in eight consecutive patients (6 females and 2 males) with tennis elbow who underwent arthroscopic surgery were included in this study. The mean age was 45years (38–66years), and the mean duration of symptoms before surgery was 23months (13–52months). Operative treatment consisted of an arthroscopic inspection and debridement of the ECRB origin. Control tissues were obtained from biopsy of the ECRB capsule in two patients with osteochondritis dissecance of the capitellum who underwent arthroscopic resection of loose bodies. The tissue specimens were investigated immunohistochemically with antibodies delineating general (PGP9.5), sensory (SP/CGRP), and sympathetic (NPY) nerve patterns. ResultsIn the non-tendinosis control tissue, SP/CGRP and NPY immunoreactions were heterogeneously distributed in association with blood vessels. Pathologic evaluation of the biopsy tissue showed atypical fibrous granulation containing numerous vessels and nerve structures in all eight patients. Marked reactions to PGP 9.5 took the form of nerve fibers associated with arteries and arterioles in the atypical granulation. Most of the perivascular innervation was found to express NPY. The immunoreactions for SP and CGRP were invariably weak. ConclusionIncreased perivascular sympathetic innervation accompanied with loss of sensory innervation at the undersurface of the ECRB tendon may play a role in chronic pain generation in recalcitrant tennis elbow. Level of evidenceDiagnostic, Level IV.

Arthroscopic Treatment of Lateral Epicondylitis

The primary cause of lateral epicondylitis of the elbow is chronic tendinopathy of the extensor carpi radialis brevis origin. Despite advances in the understanding of the pathoanatomy of lateral epicondylitis, a lack of consensus remains regarding the optimal surgical treatment when nonoperative treatment fails. Many different surgical procedures have been described in the literature, including several arthroscopic techniques. In this article, we describe our technique of arthroscopic evaluation, identification, and resection of symptomatic tendinosis tissue of the extensor origin. In our experience, arthroscopic management of patients with recalcitrant lateral epicondylitis can produce clinical improvement with successful long-term outcomes.

Selective 360° Percutaneous Extensor Carpi Radialis Brevis Tendon Release for Tennis Elbow

The purpose of this study was to define in volunteers and cadavers the positions of structures at risk and the extensor carpi radialis brevis (ECRB) origin limits for sonographically guided percutaneous tendon release in tennis elbow. First, in volunteers, we used Doppler sonography to determine the position (danger zone) of the structures at risk (neurovascular bundle and radial collateral ligament) from the most lateral point of the epicondyle (point of entry). Second, in cadavers, we studied the footprint of the ECRB's origin for finally performing sonographically guided tendon release (1- to 2-mm incision) away from the danger zone. Efficacy was measured in terms of detachment ratios for the ECRB and safety as the absence of neurovascular bundle or radial collateral ligament injuries. In 10 volunteers (20 elbows), the neurovascular bundle was located 18.1 mm or greater anteromedially from the point of entry. The neurovascular bundle was not in direct contact with the bone. In 13 formaldehyde-embalmed cadaver elbows, the distance between the origin of the ECRB and the radial collateral ligament was 0 mm or greater. The anterior origin of the ECRB did not contact the neurovascular bundle. The maximum attachment limits of the ECRB were at 15, 5, 15, and 16 mm from the point of entry (anterior, posterior, proximal, and distal margins, respectively). Average detachment ratios were excellent for anterior and distal margins and good for posterior and proximal margins, without neurovascular bundle or radial collateral ligament injuries. This study determined a danger zone to avoid and an area of probability in which to enclose most of the ECRB's origin for sonographically guided percutaneous tendon release. A 360° ECRB detachment can be performed safely and effectively. Clinically, sonographically guided percutaneous tendon release should selectively target pathologic regions.

Arthroscopic Treatment of Lateral Epicondylitis

Lateral epicondylitis refractory to conservative care can be effectively treated by arthroscopic release of the extensor carpi radialis brevis origin. Advantages to the technique include the ability to address other intra-articular sources of pain (capsular tears, radiocapitellar plica, etc.), a potentially faster return to work and sports, and a smaller incision. This article provides step-by-step descriptions and illustrations of the surgical technique.

Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis

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.

Magnetic Resonance Imaging Signal Abnormalities in Enthesopathy of the Extensor Carpi Radialis Longus Origin

Some surgeons use magnetic resonance imaging (MRI) findings in patients with enthesopathy of the extensor carpi radialis brevis (ECRB) origin (commonly referred to as lateral epicondylitis) to plan and justify surgical treatment. Overinterpretation of defects of the origin of the ECRB or associated abnormalities of the lateral collateral ligament (LCL) could affect decision-making. We tested the hypothesis that patients with MRI signal abnormalities consistent with enthesopathy of the ECRB are equally likely to have findings consistent with an ECRB defect or LCL abnormality whether they are being evaluated as part of preoperative planning for lateral elbow pain or for an elbow condition that does not feature lateral elbow pain. For each of 24 consecutive patients with enthesopathy of the ECRB who had MRI for preoperative evaluation, we selected 2 age- and gender-matched controls from a list of patients who had an elbow MRI to evaluate other elbow problems. The origin of the ECRB and the LCL were specifically evaluated. Patients diagnosed with enthesopathy of the ECRB were significantly more likely than control patients to have signal changes consistent with enthesopathy of the ECRB origin (24 of 24 vs 9 of 48; p < .001). The proportion of patients with a partial thickness defect of the ECRB origin (14 of 24 vs 4 of 9) was comparable between patients diagnosed with enthesopathy of the ECRB origin and controls. Signal changes in the LCL were comparable in patients diagnosed with enthesopathy of the ECRB origin and control patients (8 of 24 vs 2 of 9; p = .27), and no patient had clinical evidence of instability. Use of MRI in the management of patients with enthesopathy of the ECRB origin merits further study.

Functional outcomes after arthroscopic treatment of lateral epicondylitis

Background.The purpose of this study was to evaluate surgical outcomes of arthroscopic débridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes. Methods.A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of débridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months). Results.After surgery, according to the patients’ reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P <0.0001), and that during activity improved from 7.8 points to 0.9 points (P < 0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P < 0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P = 0.02) and receiving public assistance (P = 0.01) were significantly associated with worse DASH scores. Conclusions.Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score.

Long-term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

Background: The most commonly accepted theory pertaining to the pathogenesis of the lateral epicondylitis points to a degenerative, non-inflammatory lesion in the origin of the extensor carpi radialis brevis (ECRB). The lesion, caused by overuse, is characterized by microscopic tears of the ECRB origin that eventually are replaced by non-reparative tissue consisting of disorganized collagen, immature fibroblasts, and vascular elements. Currently, there is a lack of consensus on which management is best suited for patients with lateral epicondylitis – operative or non-operative. While most patients respond to non-operative management, up to 25% of patients has been identified in the literature as requiring operative management. Several operative techniques with documented short-term success have been described in the literature. This study evaluates the long-term outcome of an arthroscopic treatment of lateral epicondylitis performed by the first author.

Lateral epicondylitis: Anatomic relationships of the extensor tendon origins and implications for arthroscopic treatment

The purpose this study was to provide an understanding of the location of the extensor carpi radialis brevis (ECRB) and its relationship to surgically relevant landmarks. In part I, 20 fresh-frozen cadaveric elbows were dissected, and the anatomic boundaries of the ECRB origin were determined, including its relationship to the extensor carpi radialis longus, the extensor digitorum communis, the lateral epicondyle, the radiocapitellar joint, the lateral collateral ligament, and the elbow capsule. All measurements were made by 3 separate investigators. Whereas the ECRB and extensor digitorum communis converged distal to the radiocapitellar joint, the bony origin of the ECRB was reliably identified beneath the distal-most aspect of the supracondylar ridge, with a mean dimension of 13 +/- 2 mm in length by 7 +/- 2 mm in width. Part II was performed on 10 separate specimens to document whether the ECRB tendon could be identified and released arthroscopically. In all specimens, the ECRB origin was safely and completely released, by use of the landmarks defined in part I. When the ECRB is released arthroscopically, the elbow capsule must be resected and the tendinous origin of the ECRB released from the top of the capitellum to the midline of the radiocapitellar joint.