CHAPTER 51 • ELBOW TENDINOSIS 297reattachment, bone grafting, drilling, and debride-
ment. Operative techniques continue to evolve (Vitale
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51 ELBOW TENDINOSIS
Robert P Nirschl, MD, MS
Derek H Ochiai, MDINTRODUCTION
- Elbow tendinosis is a result of tendon overuse and a
failure of tendon healing. - Elbow tendinosis can affect the lateral side (extensor
carpi radialis brevis, extensor digitorum communis),
the medial side (pronator teres, flexor carpi radialis),
or the posterior side (triceps) (Nirschl, 1992)
SYMPTOMS/SIGNS- Initial symptoms are activity related pain followed by
pain at rest as the condition becomes more chronic. - Some loss of extension common in medial elbow
tendinosis
•Tenderness over lateral or medial tendon origins or
posterior insertion of triceps
•Pain with provocative procedures (resisted wrist/
finger extension for lateral tendinosis, wrist flexion/
pronation for medial tendinosis, and elbow extension
for posterior tendinosis) - Since medial and lateral affected tendon units cross
the elbow joint, pain is more severe with provocative
testing with the elbow in extension. Therefore, pain
with provocative testing with the elbow flexed indi-
cates more severe involvement. - Functional strength loss is common.
HISTOPATHOLOGY- Histology of surgically resected tissue fails to reveal
inflammatory cells. Thus, the term tendinosisis prefer-
able to tendonitis. - The epicondyle (bone) itself is not affected in the
disease process. Therefore, epicondylitis is a misnomer;
however, bony exostosis may be noted as a com-
panion problem in 20% of lateral elbow tendinosis
cases.
•Pathological tendinosis tendon shows disruption of
normal collagen matrix by the characteristic invasion
of fibroblasts and vascular granulation tissue termed
angiofibroblastic proliferation(Nirschl and Pettrone,
1979).
DIFFERENTIAL DIAGNOSIS/
ASSOCIATED LESIONS- Lateral tendinosis can be confused with the rare entity
of posterior interosseous nerve(PIN) entrapment that
would have diffuse pain along the radial nerve in the
extensor mass of the proximal forearm, painful resis-
ted supination, and electromyogram(EMG) changes
of distal muscle groups (Lubahn and Cermak, 1998). - Lateral tendinosis can be seen in combination or asso-
ciation with intra-articular abnormalities such as syn-
ovitits, plica, chondromalacia, and osteochondritis
dessicans(OCD). - Medial elbow associated abnormalities may include
degeneration/rupture of medial collateral ligament,
entrapment of the ulnar nerve, and congenital sublux-
ation of the ulnar nerve.