Extensor Carpi Radialis Brevis Tendon Research Articles

Ultrasound Measurements of the ECRB Tendon Shows Remarkable Variations in Patients with Lateral Epicondylitis.

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. 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. The average tendon length was 1.68cm (range 1.27-1.98; SD 0.177). Compared to women, the ECRB tendon of men was on average 0.12cm longer. Overall, the average distance from cutis to the center of the ECRB was 0.75cm (range 0.50-1.46cm; SD 0.210), the average length of the junction was 0.55cm (range 0.35-0.87; SD 0.130), and the distance from cutis to middle of the osteotendinous junction was 0.73cm (range 0.40-1.25cm; SD 0.210). The size and depth of the ECRB tendon in patients with LE is largely variable. While there are no studies yet suggesting sono-guided injection to be superior to that of blind injection, the anatomic variability of this study suggests that the accuracy of injection therapy for LE might be compromised when based solely on bony landmarks and therefore not fully reliable. As a result, there is value in further studies exploring the accuracy of the ultrasound guided injection techniques.

Lateral Epicondylitis Debridement and Repair Using Knotless Suture Anchor

Lateral epicondylitis, or tennis elbow, involves degeneration of the extensor carpi radialis brevis tendon and is often self-limiting, with surgery reserved for recalcitrant cases. Surgical management of tennis elbow consists primarily of either debridement alone or debridement with repair. Surgical repair is often performed using either a suture or a suture anchor. Good outcomes have been reported using standard repair methods; however, complications exist. Complications include potential loss of grip strength with debridement alone, as well as soft-tissue irritation caused by a prominent suture or knot stack after suture repair and suture anchor techniques. We describe a technique for debridement and repair of the extensor carpi radialis brevis tendon to the lateral epicondyle of the humerus using a knotless suture anchor, allowing for a watertight anatomic repair, maximum preservation of grip strength, and absence of a knot stack and resultant suture prominence.

Arthroscopic Release of Resistant Tennis Elbow

Background: Lateral epicondylitis is a common cause of lateral elbow pain; characterized as an overuse injury of the forearm and the wrist extensors. The elbow arthroscopy has an important role for diagnosing and treating many elbow disorders. Objective: The aim of this study was to evaluate the effectiveness of the arthroscopic intervention as a minimally invasive procedure in management of resistant cases with tennis elbow after failure of conservative treatment. Material and methods: A prospective study included 30 patients with resistant lateral epicondylitis treated with arthroscopic debridement of extensor carpi radialis brevis tendon. This study was carried out in the period between January 2017 and February 2019 at Al Azhar University Hospitals. The patients were evaluated pre-, intraand post-operatively for their elbow function and pain using the following scores: Mayo Elbow Performance Index (MEPI), Disability of the Arm, Shoulder and Hand (DASH), The Nirschl staging score and visual analog scale (VAS) for pain. Result: A total of 30 patients (12 male and 18 female) were included. The mean of MEPI score improved from 71.33 to 92.55, DASH score from 28.53 to 3.18, Nirschl scale improved from 4.13 to 1.47 and pain VAS improved from 5.27 to 1.47. There was a significant difference between from before to after surgery for the four functional scores. 2 patients complicated with ulnar nerve injury. Conclusion: The arthroscopic treatment of tennis elbow was shown to be an effective therapeutic option when appropriately indicated and performed in refractory cases. It also allowed excellent viewing of joint space for diagnosis and treatment of any associated pathological conditions with a minimally invasive procedure.

MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries

ObjectiveTo report patterns of MRI findings involving carpal boss and extensor carpi radialis brevis (ECRB) tendon insertion in individuals with overuse-related or post-traumatic wrist pain.Materials and MethodsEighty-four MRI cases with carpal bossing between December 2006 and June 2015 were analyzed by two fellowship-trained musculoskeletal radiologists. The following MRI findings were reviewed: type of carpal bossing (bony prominence, partial coalition, os styloideum), insertion of ECRB tendon (to the 3rd metacarpal, to carpal boss or to both), bone marrow edema (BME), insertion site, and tenosynovitis/tendinosis of ECRB tendon. Clinical information on wrist pain was available on 68 patients.ResultsFused carpal bossing was detected in 21%, partial coalition in 35%, and os styloideum in 44% of the cases. Regional BME was observed in 64% of the cases. When BME specifically at the carpal boss was assessed, 78% of stable and 50% of unstable bosses showed BME (p = 0.035). ECRB tendon inserted on a carpal boss in 20%, on the 3rd metacarpal bone in 35%, and on both sites in 45% of the cases. As BME at the carpal boss was assessed, BME was detected at the respective insertion sites in 71%, 35%, and 66% of the cases (p = 0.015). Dorsal wrist pain was associated with BME as 75% of the patients had regional BME in the vicinity of the carpal boss (p = 0.006).ConclusionA spectrum ranging from complete fusion of a boss to an entirely unfused os styloideum exists with a variable ECRB insertional anatomy. BME at the carpal boss is a consistent MRI finding.

A Protocol to Acquire the Degenerative Tenocyte from Humans.

Tendinopathy, a painful condition that develops in response to tendon degeneration, is on the rise in the developed world due to increasing physical activity and longer life expectancy. Despite its increasing prevalence, the underlying pathogenesis still remains unclear, and treatment is generally symptomatic. Recently, numerous therapeutic options, including growth factors, stem cells, and gene therapy, were investigated in hopes of enhancing the healing potency of the degenerative tendon. However, the majority of these research studies were conducted only on animal models or healthy human tenocytes. Despite some studies using pathological tenocytes, to the best of our knowledge there is currently no protocol describing how to obtain human degenerative tenocytes. The aim of this study is to describe a standard protocol for acquiring human degenerative tenocytes. Initially, the tendon tissue was harvested from a patient with lateral epicondylitis during surgery. Then biopsy samples were taken from the extensor carpi radialis brevis tendon corresponding to structural changes observed at the time of surgery. All of the harvested tendons appeared to be dull, gray, friable, and edematous, which made them visually distinct from the healthy ones. Tenocytes were cultured and used for experiments. Meanwhile, half of the harvested tissues were analyzed histologically, and it was shown that they shared the same key features of tendinopathy (angiofibroblastic dysplasia or hyperplasia). A secondary analysis by immunocytochemistry confirmed that the cultured cells were tenocytes with the majority of the cells having positive stains for mohawk and tenomodulin proteins. The qualities of the degenerative nature of tenocytes were then determined by comparing the cells with the healthy control using a proliferation assay or qRT-PCR. The degenerative tenocyte displayed a higher proliferation rate and similar gene expression patterns of tendinopathy that matched previous reports. Overall, this new protocol might provide a useful tool for future studies of tendinopathy.

A Comparison of Radiofrequency-Based Microtenotomy and Arthroscopic Release of the Extensor Carpi Radialis Brevis Tendon in Recalcitrant Lateral Epicondylitis: A Prospective Randomized Controlled Study

To compare the clinical effects of radiofrequency (RF)-based microtenotomy and arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in patients with recalcitrant lateral epicondylitis through a prospective randomized controlled study. A total of 46 patients were randomly assigned to receive arthroscopic release (group A, 24 patients) or RF-based microtenotomy (group B, 22 patients). The visual analog scale (VAS) score for pain, flexion-extension arc, operation time, Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Mayo Elbow Performance Score (MEPS), and grip power of groups A and B were compared during the recovery phases for up to 2 postoperative years. Both groups showed statistically significant functional improvement compared with their preoperative grip strength and DASH, VAS, and MEPS scores at 2years after surgery (P < .05). There were no differences in postoperative pain relief or functional restoration between the 2 groups during the recovery phases, however the mean operation time for group B (41.4 ± 5.2minutes) was significantly shorter than that for group A (15.6 ± 3.6minutes, P < .001). In group B, 1 patient underwent revision surgery due to postoperative ECRB rupture, and 1 patient in group A underwent open release for persistent postoperative discomfort. RF-based microtenotomy for treating recalcitrant lateral epicondylitis provided clinical outcomes comparable with those from arthroscopic release of ECRB tendon during the recovery phase. RF-based microtenotomy is considered as one of the surgical procedures for treating recalcitrant lateral epicondylitis, with the advantages of reliable elbow functional restoration and significantly shorter operation time. Level I, prospective randomized trial.

ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW)

In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB) without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р0,05). VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р0,05). Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS) in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and increased bleeding of the wound. Patients after simple release of ECRB demonstrated minimal postoperative pain which allows early rehabilitation and return to daily and professional activities.

Effect of wrist and finger flexion in relation to strain on the tendon origin of the extensor carpi radialis brevis: A cadaveric study simulating stretching exercises

BackgroundStretching exercises based on wrist flexion-ulnar deviation with elbow extension, forearm pronation, and additional index or middle finger flexion have been used to stretch the wrist extensors for lateral epicondylitis. The purpose of this study was to quantify the strain on the tendon origin of the extensor carpi radialis brevis in cadaver specimens during these stretching exercises. MethodsWe used 8 fresh frozen/thawed cadaveric upper extremities. The strain on the extensor carpi radialis brevis tendon origin was measured by the addition of 4 types of traction (no traction, wrist flexion-ulnar deviation, and index or middle finger flexion in combination with wrist flexion-ulnar deviation) in 7 sequential elbow flexion angles during forearm pronation. Two types of varus stress load to the elbow (none, gravity on the forearm) were also applied. FindingsA significant increase in strain was obtained by wrist traction with 0°, 15° and 30° of elbow flexion (P<0.05). The strain was also significantly increased by adding finger traction (P<0.05) and varus stress load (P<0.05). A maximum strain value of 5.30 (SD 1.73) % was obtained when traction on the middle finger in combination with traction of the wrist was added at 15° elbow flexion with varus stress load. InterpretationThe present study provides data about the amount of strain on the extensor carpi radialis brevis tendon during stretching exercises of the wrist and finger extensors. The results of this study could be applied to stretching exercises for patients with lateral epicondylitis.

Tendon transfer to restore the extension of the thumb using the extensor carpi radialis brevis: A long-term follow-up

The present study aimed to investigate the long-term functional and clinical outcomes of a tendon transfer to restore the extension of the thumb using the extensor carpi radialis brevis. From June 2005 to September 2012, eight patients (six males; two females) with a mean age of 30 years (range, 16-52 years) who suffered rupture or division of extensor pollicis longus underwent a tendon transfer to restore the extension of the thumb using the extensor carpi radialis brevis. The range of motion, pinch, and grip strength of thumb were compared with the nonoperated hand and evaluated for all the study patients using the Geldmacher scoring system. At an average follow-up of 56 months, all eight patients could extend their thumbs fully and were assessed as good or excellent according to the Geldmacher scoring system. Average grip and tip pinch strengths of the operated hand were 95% (34.9kg±14.0kg vs. 36.6kg±14.6kg) and 92% (9.2kg±4.8kg vs. 9.9kg±4.7kg) of the nonoperative side, respectively. There was no marked loss of extension motion or strength of the wrist nor any other postoperative complications. The procedure of transferring the extensor carpi radialis brevis tendon to the extensor pollicis longus provides excellent long-term clinical results for restoring the extension of the thumb. The procedure is safe, with few complications, and it can be an alternate procedure of restoring the extension of the thumb.

Extensor carpi radialis brevis transfer to extensor pollicis longus: an anatomical study

Objective To investigate the anatomical basic of extensor carpi radialis brevis (ECRB) tendon trans-ferring to extensor pollicis longus (EPL) tendon. Methods Twelve sides of ECRB and EPL in fresh adult cadaver’s forearms were collected, and the anatomical model of ECRB transferring to EPL was set up in all the forearms. The ana-tomical parameters of EPL were measured before and after anatomical model established. Results The effective trans-ferring length of ECRB was (3.5±0.8) cm; the maximum circumferential of ECRB and EPL were (8.5±0.8) cm and (3.6±0.3) cm (P >0.05) , the ratio of muscle cross-sectional area was 5.57; After the anatomical model setting up, anatomic an-gles of EPL was (30±7) °, which was a decrease of (20±5) ° comparing with the preoperative angel of (50±9) ° (P >0.05) ; Thumb extension angle was (50±12) °, which was a decrease of (8±3) ° comparing with the preoperative angel of (58 ±16) ° (P 0.05) ; Thumb tip lifting height was (2.3±0.9) cm, which was a decrease of (1.2±0.6) cm comparing with the preoperative height (3.5±1.2) cm (P >0.05). Conclusion Based on the measurement of the anatomic parameters of ECRB and EPL, the ECRB has enough length and muscle force to reconstruct the function of EPL. The thumb had a good extension appearance and accorded with the rule of biomechanics after setting up the anatom-ical model of ECRB transferring to EPL. This study will provide the anatomical evidence for further clinical application Key words: Extensor carpi radialis brevis; Extensor pollicis longus; Tendon transfer; Applied anatomy

Advances on open surgery of tennis elbow

Currently, surgical treatments in tennis elbow include open, arthroscopic and percutaneous procedures. Open surgery, having definite curative effects, is commonly used. There are different surgical methods based on different hypotheses about the pathogenesis of tennis elbow, such as detachment of common extensor origin, resection of annular ligament, denervation surgery and resection of microvascular nerve bundle. There is a huge difference in open surgery of tennis elbow between China and abroad. Debriding or releasing extensor carpi radialis brevis and common extensor tendon are mostly used abroad though it re-mains controversial whether we should release or debride with tendon, as well as whether it is better to decorticate on lateral epi-condyle or not. In China, tennis elbow is treated with resection of microvascular nerve bundle except for debridement and release of tendon. As for evaluation criteria, the following methods, grip strength, grading system and visual analogue scale have been used in researches. However, cure rate and response rate are valuation criteria for resection of microvascular nerve bundle in China. The evaluation criteria are different among various surgical methods, even in the methods, especially for grading system. Each re-search has unique standards to define excellent, good, fair and poor outcomes. Complications of tennis elbow open surgery are rare, while subcutaneous hematoma is the common complication.

The Three-Portal Technique in Arthroscopic Lateral Epicondylitis Release.

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.

The Effect of Capitate Position on Coronal Plane Wrist Motion After Simulated 4-Corner Arthrodesis

The objective of this study was to examine the effect of altering the capitolunate relationship on coronal-plane wrist motion after scaphoidectomy and simulated 4-corner arthrodesis. Two positions of different capitolunate alignments were compared: "anatomic" (unchanged from pre-fusion) and "lunate-covered" (capitate translated to cover the lunate). We hypothesized that wrist resting posture would be altered and radial-ulnar motion would diminish after 4-corner arthrodesis in the lunate-covered position when compared with normal wrists. Six human cadaveric limbs were disarticulated at the elbow and mounted on a custom jig. The resting position of the wrist was recorded with no load applied, followed by a load of 44 N applied to the flexor carpi radialis, extensor carpi radialis longus, and extensor carpi radialis brevis tendons to simulate radial deviation and to the flexor carpi ulnaris and extensor carpi ulnaris tendons to simulate ulnar deviation. Scaphoidectomy was performed and 2 methods of 4-corner arthrodesis with different capitolunate coronal alignments were studied in random order. Range of motion was compared using one-way analysis of variance and Bonferroni correction. The "lunate covered" wrist demonstrated significantly greater radial resting posture than that of the preoperative wrist. Under a 44 N load, the lunate-covered position had significantly greater radial motion than the preoperative radial motion. Wrists fused in the "anatomic" position did not differ significantly from the preoperative wrists in posture or range of motion. In this cadaveric model, complete covering of the capitate head by the lunate placed the wrist in increased radial deviation compared with the anatomic posture. Changes induced in the resting tension of the extrinsic wrist ligaments serve as a reasonable explanation for the increased radial posture and motion. In a clinical setting, these changes may affect postoperative wrist posture and function. Maintaining anatomic lunate position leads to preservation of greater wrist motion and anatomic alignment in a patient undergoing 4-corner arthrodesis.

Injection of tennis elbow: Hit and miss? A cadaveric study of injection accuracy

Different injection therapies are used in the treatment of lateral epicondylitis (LE). Usually, the extensor carpi radialis brevis (ECRB) tendon is affected. Therefore, an injection should be aimed at the origin of this tendon. This study demonstrates the accuracy of manual injections in the treatment of LE. Ten surgeons have injected a cadaver elbow with acrylic paint, using the same injection technique (i.e. number of perforations, amount of injected fluid) that they in daily practice would use in the treatment of LE. After the injection, an arthroscopy and dissection of the elbow were performed. The injection technique and localization of acrylic paint were reported. Only a third of the injections were (partially) localized in the ECRB tendon; 60% were localized intra-articular. Injections carried out manually for the treatment of LE are not accurate, resulting in the majority being localized intra-articular. For future research to the effect of injection therapy in the treatment of LE, it is important that injections should be performed in a reproducible and standardized way.

A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis.

BackgroundTennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. Most cases resolve within 2 years of symptom onset, but a subset of patients will develop persistent symptoms despite appropriate conservative management. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. This procedure involves the arthroscopic release of the extensor carpi radialis brevis tendon (ECRB) origin at the elbow. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. However, in order to justify its widespread use and growing popularity, a high level of evidence study is required. The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis.MethodsWe will conduct a prospective single center, double-blind, randomized sham-controlled parallel arm trial evaluating the efficacy of arthroscopic tennis elbow release in adult patients with symptoms for at least 6 months. Patients will undergo intraoperative randomization after diagnostic arthroscopy of the elbow to receive either ECRB release (through the creation of a lateral portal) or a sham lateral portal and no ECRB release. The primary outcome will be the Mayo Elbow Performance Score (MEPS) at 1 year follow-up. Secondary outcomes will be the abbreviated Disability of the Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons elbow (ASES-e) score and grip strength at 3, 6, 12 and 24 months as well as return-to-work time, ability to return to full duty and adverse outcomes.DiscussionResults of this study will provide empirical high quality evidence to guide clinical decision-making in patients with chronic tennis elbow.Trial registrationNCT02236689 (September 8, 2014)

Non-anatomical reconstruction of lateral ulnar collateral ligament of the elbow after tumor resection.

We present the case of an 80-year-old man with a tumor recurrence on his right arm 6 years after initial treatment. The lateral aspect of the elbow joint, involving overlaying skin, muscles, tendons, joint capsule, lateral collateral ligament complex, the lateral 1/3 of the capitellum, and lateral epicondyle of humerus were excised in the tumor resection. Intraoperative assessment revealed multidirectional instability of the elbow, and joint stabilization was needed. Because the lateral epicondyle was resected, graft placement in an anatomical position was impossible to carry out. Therefore, non-anatomical reconstruction of lateral ulnar collateral ligament with palmaris longus tendon graft was performed. The skin was reconstructed using an antegrade pedicled radial forearm flap. For wrist extension reconstruction, the pronator quadratus tendon was transferred to the extensor carpi radialis brevis tendon. One year after the operation, elbow range of motion was 5–130°. The patient remains symptom free. The Mayo elbow performance score is good. The Musculoskeletal Tumor Society rating score is excellent. To our knowledge, this is the first report of an elbow lateral ulnar collateral ligament reconstruction after tumor resection.

Long-Term Functional Evaluation on Tendon Transfer to Restore Extension of the Thumb using Extensor Carpi Radialis Brevis

Purpose: To investigate the long-term functional and clinical outcomes of a tendon transfer to restore extension of the thumb using extensor carpi radialis brevis Methods and materials: From Jun 2005 to Sep 2012, 8 patients with rupture or division of extensor pollicis longus (6 males, 2 females; aged 16-52 years, mean age 30 years) underwent a tendon transfer using the extensor carpi radialis brevis to restore extension of the thumb. All patients were assessed by Geldmacher score system, mobility, pinch and grip strength of thumb comparing to the non-operated hand over an average of 36 months (range, 24–84 months) after the operation. Result: At an average follow-up of 36 months, all eight patients were able to extend their thumbs fully, and assessed as good or excellent by Geldmacher score system. Average grip strength of the operated hand was equal to that of the contra lateral hand, and tip pinch strengths were 92% of the contra lateral hand. There was no marked loss of extension motion and strength of wrist, and no other postoperative complications. Conclusions: The procedure of extensor carpi radialis brevis tendon transfer to extensor pollicis longus provides excellent long-term clinical results for restoring extension of the thumb. The procedure is safe, with few complications, which can be an alternate procedure of restoring extension of the thumb.

Forearm position's alteration of radial-head impingement on wrist-extensor tendons.

Lateral epicondylalgia, pain at the lateral elbow, is commonly associated with extensor carpi radialis brevis tendinopathy. The radial head, which abuts the extensor tendons and is elliptical in shape, may affect the extensor tendons during pronation of the forearm. Cadaverous studies have shown that the radial head may act as a cam in pronation, to offer a mechanical advantage to the common extensor tendon and to mitigate load on the origin of the extensor carpi radialis brevis tendon. To determine the effect of radial-head position on the wrist-extensor tendons in vivo. Repeated-measures design. Laboratory. 22 participants (12 male, 2 left-handed). Distance (mm) from subcutaneous fascia to radial head measured by ultrasound. The radial head in supination was significantly deeper than either pronation or midprone, indicating a smaller cam effect in supination. The authors recommend that the effect of radial-head position and its relationship to the area of tendon pathology be considered clinically in the rehabilitation of patients suffering from lateral epicondylalgia.

Variations in extensor carpi radialis longus and brevis - A cadaveric study

The Extensor Carpi Radialis Longus (ECRL) and Extensor Carpi Radialis Brevis (ECRB) are two of the superficial muscles of e xtensor compartment of forearm. The extensor carpi radialis brevis is involved in tennis elbow. The surgeons performing Z shaped tenotomy on tennis elbow to lengthen the tendon of ECRB must be aware of the variation in order to avoid unwanted complications. Recently, ECRB has also gained importance for use in free functional muscle transfer. In cases of variation of extensor muscles like fusion of muscle bellies or splitting of tendon and in cases of absent ECRB, the entrapment neuropathy of Radial nerve or Posterior interosseous nerve should also be kept in mind. In this study, w e have described some variations of ECRL and ECRB which were different from what has already been reported as they are clinically important. Methods: 30 upper limbs from 15 formalin fixed adult human cadavers were dissected to study the ECRL and ECRB. Results: Out of 15, 4 cadavers showed variations. ECRL showed a split of its tendon into two in 3 limbs belonging to 2 cadavers in which one cadaver showed bilateral split. ECRB showed a similar split of tendon in two limbs. One of the limbs showed complete absence of ECRB. Bellies of ECRL and ECRB fused to form a single mass in 3 limbs. Conclusions: The additional tendons noted in the present study could be utilized effectively and reliably in tendon transfers and in surgi cal rehabilitation in patients with paralytic disorders. Keywords: Tennis elbow, Variations, Tendon transfer.

Arthroscopic Management of Lateral Epicondylitis

The pathoanatomy of lateral epicondylitis has been well described, with the essential lesion occurring at the origin of the extensor carpi radialis brevis tendon. It is widely accepted that nonoperative management remains the initial treatment of choice for this condition. However, when nonoperative management fails, operative intervention is indicated. Multiple surgical procedures have been described for the treatment of recalcitrant lateral epicondylitis, including both open and arthroscopic procedures. There is a lack of consensus as to which procedure provides the best outcomes and long-term relief. In this article, we describe our technique for arthroscopic evaluation, identification, and resection of the abnormal tendinosis at the extensor origin. In our experience, arthroscopic management of lateral epicondylitis can effectively resect the abnormal tendinosis and provide long-term relief with patient satisfaction.