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Richly innervated soft tissues covering the superficial aspect of the extensor origin in patients with chronic painful tennis elbow - Implication for treatment?
Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. 2Dr. Alfen, Orthopaedic Spine Center, Wuerzburg, Germany.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. ISEH, University College London Hospitals, UK; Pure Sports Medicine Clinic, London, UK.
2017 (English)In: Journal of Musculoskeletal and Neuronal Interactions - JMNI, ISSN 1108-7161, Vol. 17, no 2, 97-103 p.Article in journal (Refereed) Published
Abstract [en]

Background: Tennis elbow is difficult to treat. The results of surgical treatments are not convincing. Treatment studies on Achilles and patellar tendinopathy targeting the richly innervated and vascularized soft tissues outside the tendon have shown promising outcomes. The innervation patterns in the fibrous/fatty tissues superficially to the elbow extensor origin have not been clarified.

Methods: Nine tissue specimens from the fibrous/fatty tissue covering the extensor origin was taken from seven patients (mean age: 45 years) undergoing surgical treatment for chronic painful tennis elbow. The specimens were stained for morphology (haematoxylin & eosin, H&E) and immunohistochemically for general nerve marker protein gene product 9.5 (PGP 9.5) and markers for sympathetic (tyrosine hydroxylase, TH) and sensory nerve fibres (calcitonin gene-related peptide, CGRP).

Results: All specimens contained multiple blood vessels and nerve structures indicated by morphology and immunoreactions. There was a frequent occurrence of TH reactions, especially peri-vascularly, but also in nerve fascicles. Immunoreactions for CGRP were seen in nerve fascicles and isolated nerve fibres.

Conclusion: The results provide new information on the innervation patterns of the superficial tissues of the extensor origin and their potential as source of tennis elbow pain. Level of Evidence: IV.

Place, publisher, year, edition, pages
2017. Vol. 17, no 2, 97-103 p.
Keyword [en]
Innervation, Tennis Elbow, Lateral Epicondylitis, Superficial, Soft Tissue
National Category
Clinical Laboratory Medicine
Identifiers
URN: urn:nbn:se:umu:diva-138047ISI: 000405504200011PubMedID: 28574416OAI: oai:DiVA.org:umu-138047DiVA: diva2:1130835
Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2017-08-11Bibliographically approved

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CiteExportLink to record
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