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8 Superficial Tissues Richly Innervated In Tennis Elbow Patients – Implications For Treatments?
  1. Håkan Alfredson1,
  2. Christoph Spang2
  1. 1Sports Medicine Unit, University of Umeå, Sweden
  2. 2Section for Anatomy, Umeå University, Sweden

Abstract

Introduction Tennis elbow/extensor carpi radialis brevis (ECRB) tendinopathy is well known to be difficult to treat. There is no concensus about treatment [Bisset, 2005].

Material and methods Five patients (3 females and 2 males, mean age 43 years) with a long duration (12–48 months) of pain symptoms related to Tennis elbow were in local anaesthesia treated with an ultrasound (US)+Doppler (CD)-guided open scraping procedure. Where the US+CD examination showed a localised high blood flow, there was macroscopically a richly vascularised fatty infiltration.

This tissue, containing paratendinous fibrous tissue, blood vessels and fat, was carefully scraped loose and sent for immunohistochemical staining. The general nerve marker PGP 9.5 was studied.

Results In all specimens there were multiple nerve structures, often located in close relation to blood vessels and sometimes also inside blood vessel walls (Figure 1).

Abstract 8 Figure 1
Abstract 8 Figure 1

Reactions close to blood vessels (arrowheads) and in the blood vessel wall (arrows; asterisk indicates vessel wall)

Discussion These findings might indicate that a major source of pain related to Tennis elbow is located in the tissues superficial to the extensor origin.

Characterisation of the nerves is on-going. These new findings might have implications for new treatment strategies.

Reference Bisset et al. Br J Sports Med. 2005;39:411–422

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