Abstract
Tennis elbow, extensor carpi radialis brevis (ECRB) tendinosis, is a condition with unknown etiology and pathogenesis, known to be difficult to treat. The pain mechanisms have not been fully clarified, but involvement of a neurogenic inflammation mediated via the neuropeptide Substance-P (SP), has been suggested. In this investigation, grey-scale ultrasonography (US) and colour Doppler (CD) was used to examine the common extensor origin in 17 patients with the diagnose Tennis elbow in altogether 22 elbows, and in 11 controls with 22 pain-free elbows. In 21/22 elbows with chronic pain from the extensor origin, but only in 2/22 pain-free elbows, vascularity was demonstrated in the extensor origin. After US and CD-guided injection of a local anaesthetic, targeting the area with vessels, the patients were pain-free during extensor-loading activity. The area with vascularity found in the extensor origin seems to be related to pain. Most likely, the findings correspond with the vasculo-neural in growth that has been demonstrated in the chronic painful Achilles tendon, and possibly have implications for treatment.
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References
Alfredson H, Ljung BO, Thorsen K, Lorentzon R (2000) In vivo investigation of ECRB tendons with microdialysis technique – no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthop Scand 71:475–479
Alfredson H, Öhberg L, Forsgren S (2003) Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? – An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc 11:334–338
Alfredson H, Öhberg L (2005) Neovascularisation in chronic painful patellar tendinosis- promising results after sclerosering neovessels outside the tendon challenges the need for surgery. Knee Surg Sports Traumatol Arthrosc 13:74–80
Alfredson H, Öhberg L (2005) Sclerosing injections to areas of neovascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 13:338–344
Åström M, Gentz CF, Nilsson P, Rausing A, Sjöberg S, Westlin N (1996) Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 25:615–620
Coonrad RW, Hooper WR (1973) Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg 55A:1177–1182
Cyriax JH (1936) The patholohy and treatment of tennis elbow. J Bone Joint Surg 18:921–940
Forsgren S, Danielsson P, Alfredson H (2005) Vascular NK-1 R receptor occurrence in normal and chronic painful Achilles and patellar tendons. Studies on chemically unfixed as well as fixed specimens. Regul Pept 126:173–181
Fridén J, Lieber RL (1994) Physiological conseqeunces of surgical lengthening of extensor carpi radialis brevis muscle-tendon junction for tennis elbow. J Hand Surg 19A:269–274
Goldie I (1964) Epicondylitis lateralis humeri (epicondylalgia or tennis elbow). A pathogenetical study. Acta Chir Scand Suppl 339:1–119
Lieber RL, Ljung B-O, Fridén J (1997) Sarcomere length in wrist extensor muscles. Changes may provide insights into the etiology of chronic lateral epicondylitis. Acta Orthop Scand 68:249–254
Ljung B-O, Forsgren S, Fridén J (1999) Substance P and calcitonin gene-related peptide expression at the extensor carpi radialis brevis muscle origin: implications for the etiology of tennis elbow. J Orthop Res 17:554–559
Maffulli N, Regine R, Angelillo M, Capasso G, Filice S (1987) Ultrasound diagnosis of Achilles tendon pathology in runners. Br J Sports Med 21:158–162
Movin T, Gad A, Reinholt FP, Rolf C (1997) Tendon pathology in long-standing Achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand 68:170–175
Nirschl RP (1992) Elbow tendinosis/tennis elbow. Clin Sports Med 11:851–870
Öhberg L, Lorentzon R, Alfredson H (2001) Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 9:233–238
Öhberg L, Alfredson H (2002) Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of new treatment. Br J Sports Med 36:173–177
Paavola M, Paakkala T, Kannus P, Järvinen M (1998) Ultrasonography in the differential diagnosis of Achilles tendon injuries and related disorders. Acta Radiol 39:612–619
Regan W, Wold LE, Coonrad R, Morrey BF (1992) Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 20:746–749
Torp-Pedersen T, Torp-Pedersen S, Bliddal H (2002) Diagnostic Value of Ultrasonography in Epicondylitis. Ann Intern Med 136:781–782
Weinberg EP, Adams MJ, Hollenberg GM (1998) Color Doppler sonography of patellar tendinosis. AJR Am J Roentgenol 171:743–744
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Zeisig, E., Öhberg, L. & Alfredson, H. Extensor origin vascularity related to pain in patients with Tennis elbow. Knee Surg Sports Traumatol Arthr 14, 659–663 (2006). https://doi.org/10.1007/s00167-006-0060-7
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DOI: https://doi.org/10.1007/s00167-006-0060-7