The Controversial Pain Syndrome of Tennis Elbow (TE): Pathogenesis and Surgical Treatment of Resistant Cases

  • Albrecht Wilhelm
Chapter

Abstract

As of today, aetiology and pathogenesis of TE are still unsolved; despite Winkworth’s statement in 1883, already, the disease can be led back to a pressure damage of the radial nerve deep branch at the supinator muscle, “where the nerve is compressed by diverse actions of muscle fibers”. Capener (J Bone Joint Surg 48B:770–773, 1966) and Roles and Maudsley (J Bone Joint Surg 54B:499–509, 1972) proved this. Nevertheless even seven recent reviews since 2003 hold the opinion TE is based on a degenerative process at the ECRB origin, mentioning the neurogenous pathogenesis, but only discussing it insufficiently. Authors agree with positive results of diverse procedures at the extensor tendon apparatus, whereas the pathogenesis of the TE is not understood. Kay (J Hand Surg 28B: 460–464, 2003) even states that pathogenesis is a “mystery”. This mystery could have been solved earlier, if innervation of the main pain area at the elbow had been taken into account (von Lanz and Wachsmuth Praktische Anatomie [Practical Anatomy], 1. Band/3. Teil: Arm. 2. Aufl. Springer, Berlin/Heidelberg, 1959; Wilhelm Z Anat Entwckl Gesch 120: 331–371, 1958; Z Anat Entwckl Gesch 123: 115–120, 1962; Die Eingriffe der Schmerzausschaltung durch Denervierung [Surgery for Elimination of Pain by Denervation]. In: Wachsmuth W, Wilhelm A (eds) Die Operationen an der Hand. In: Zenker R, Heberer G, Hegemann G (eds) Allgemeine und spezielle Operationslehre. Band X, Teil III., Springer, Berlin/Heidelberg, pp S264–S285, 1972; J Hand Surg 21B: 523–533, 1996; 2011). The pain region mentioned is exclusively innervated by fibres of the radial nerve. In this context, aimed blockades could have determined pain areas and their nervous fields of distribution.

Twenty-six facts, examination results, tests and conclusions support the exclusively neurogenous pathogenesis of TE (Wilhelm 2011); they are extensively described and discussed in this chapter. There is proof that the tendinogenous pathogenesis as discussed up to now, cannot be supported any more. Diagnostics, indications, and therapy are described in detail. Since 1991, denervation with indirect decompression of the deep branch of the radial nerve has been successful as method of choice. In a first series (1991–1994), 42 out of altogether 46 patients with surgery were followed up after 4.9 years. Results: excellent = 38 (78.6 %), good = 5 (11.9 %), fair = 3 (7.1 %). Positive results were found in 97.6 %, 1 case was unchanged (2.4 %).

In a second series (1996–2009), 28 procedures were followed up after an average time of 3.5 years. Results: excellent = 21 (75.0 %), good = 5 (17.9 %), and fair = 2 (7.1 %), resulting in 100 % of positive results.

Keywords

Radial Head Radial Nerve Extensor Tendon Pain Area Tennis Elbow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Albrecht Wilhelm
    • 1
  1. 1.AschaffenburgGermany

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