Abnormal Microvascular Responses in Lateral Epicondylitis

Smith, Rea; Papadopolous, E.; Mani, Ravi; Cawley, M. I. D.

doi:10.1093/rheumatology/33.12.1166

Cited by 46 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is a drawback since nonsensory nerves may also influence the region. A sympathetic dysfunction has, for example, been suggested in the pathophysiology of tennis elbow, based on an abnormal response in dermal perfusion at the lateral epicondyle in tennis elbow patients [Smith et al, 1994]. The aim of the present study was to investigate the entire innervation at the ECRB tendinous origin at the lateral epicondyle.…”

Section: Introductionmentioning

confidence: 94%

Sympathetic and Sensory Innervations Are Heterogeneously Distributed in Relation to the Blood Vessels at the Extensor carpi radialis brevis Muscle Origin of Man

Ljung

Forsgren

Fridén³

1999

Cells Tissues Organs

View full text Add to dashboard Cite

By using immunohistochemistry and antibodies to a general nerve marker, protein gene product (PGP) 9.5, the overall innervation at the extensor carpi radialis brevis (ECRB) muscle origin was investigated in patients with tennis elbow and in healthy controls. The autonomic innervation was studied by using antibodies to neuropeptide Y (NPY), tyrosine hydroxylase (TH), and vasoactive intestinal peptide (VIP). The sensory innervation was visualized by using antibodies to substance P and calcitonin gene-related peptide. PGP 9.5 immunoreactions were detected in association with small blood vessels and arteries and within nerve bundles. There was, however, heterogeneity in the perivascular nerve fiber distribution since some blood vessels exhibited a high degree of PGP 9.5 innervation and some negligible or no such innervation at all. There was marked TH/NPY innervation in the walls of a subpopulation of the arteries, basically no VIP-containing nerves, and sensory innervation restricted to the small blood vessels. These observations show that the ECRB muscle origin is supplied with heterogeneously distributed sympathetic and sensory innervations and, furthermore, that there appears to be an imbalance between the vasoconstrictor and vasodilator innervations along the vascular tree in this region.

show abstract

Section: Introductionmentioning

confidence: 94%

Sympathetic and Sensory Innervations Are Heterogeneously Distributed in Relation to the Blood Vessels at the Extensor carpi radialis brevis Muscle Origin of Man

Ljung

Forsgren

Fridén³

1999

Cells Tissues Organs

View full text Add to dashboard Cite

show abstract

“…Finally, 1 study demonstrated an abnormal microvascular response of the skin overlying the painful epicondylar area, indicating a potential local dysfunction of the sympathetic nervous system. 22 Lateral epicondylalgia is undoubtedly a complex condition and it may be years before all questions are answered. However, we cannot ignore the current literature, which provides consistent evidence that there is an absence of an inflammatory component.…”

mentioning

confidence: 99%

Lateral Epicondylalgia or Epicondylitis: What's in a Name?

Waugh¹

2005

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

T he condition first known as ''tennis elbow'' has been recognized for over a century. Typical signs and symptoms include pain and tenderness over the lateral epicondyle, exacerbated by resisted wrist extension and passive wrist flexion, and impaired grip strength. Although many tennis players may experience this condition, most cases are associated with work-related activities or have no obvious precipitating event. As a result, the term now most widely used is lateral epicondylitis. Yet, this name implies a pathological basis that is contrary to longstanding, albeit evolving, evidence that it is not an inflammatory condition. It is therefore recommended that it is time to adopt a new and more appropriate term, such as epicondylalgia (suffix algia means pain), that does not reflect such underlying pathology. This Journal has recently embraced this terminology. A review of the current histopathological evidence as detailed below provides a strong rationale for this change in nomenclature.The traditional view is that this condition is initiated by macroscopic or microscopic tears at the common tendon of the wrist extensor muscles due to chronic overuse. As these tears attempt to unite, the healing surfaces are pulled apart with continued use of the hand, resulting in self-perpetuating and chronic inflammation. This theory was initially put forward by Dr J. Cyriax in 1936 5 and has since been widely accepted as the most plausible pathophysiological mechanism. Consequently, treatment has focused on controlling the inflammatory response through the use of nonsteroidal anti-inflammatory drugs and physical modalities such as ultrasound and ice. This inflammatory model also led to the use of the term epicondylitis, which was considered an improvement over the colloquial term tennis elbow.Yet this theory has never been substantiated and indeed has been refuted as early as the 1970s by Dr R. Nirschl, based on the histopathological examination of over 600 cases of chronic lateral epicondylalgia. 13,17 His studies consistently demonstrated that the affected tendon (usually the extensor carpi radialis brevis [ECRB] tendon) was characterized by a dense population of fibroblasts, disorganized and immature collagen, and an absence of inflammatory cells. These findings are considered characteristic of a degenerative process, which he called ''angiofibroblastic hyperplasia,'' now commonly known as tendinosis. Further histopathological and magnetic resonance imaging studies have revealed similar histological features and have confirmed the absence of an inflammatory process. 4,[19][20][21] Recently, a study using an in vivo microdialysis technique demonstrated normal levels of E2 prostaglandin, a biochemical marker of inflammation, in ECRB tendons of patients with chronic lateral epicondylar pain.1 Histopathological examination of similar chronic tendon conditions (Achilles, rotator cuff, and patellar tendinopathies) provide further support for the tendinosisdegenerative noninflammatory paradigm for chronic overuse tendon injurie...

show abstract

“…It has been well proven by histologically that lateral epicondylitis or tennis elboe is not an acute inflammatory pathology, but instead it is failure of the normal tendon repair mechanism along with angiofibroblastic degeneration because tendons are relatively hypovascular. This hypovascularity may lead to hypoxic tendon degeneration which is main aetiology of tendinosis [3,24,25] . The traditional methods of treatment to treat tennis elbow, including rest, anti-inflammatory medications, bracing, physical therapy, iontophoresis, extra corporal shockwave, botulinum toxin, and corticosteroid injection, do not alter the tendon's poor healing properties secondary to poor vascularization of tendon, which is the basic pathophysiology in tennis elbow [1][2][3] .…”

Section: Discussionmentioning

confidence: 99%

“…But these therapies do not alter the common extensor tendon's poor healing properties secondary to poor vascularization of tendon, which is the basic pathophysiology in tennis elbow [3] . Hence these traditional therapies have shown inconsistent outcomes.…”

Section: Introductionmentioning

confidence: 99%

Treatment of lateral epicondylitis with autologous platelet rich plasma injection

Jain¹,

Rajeev²,

Banodha³

et al. 2018

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

Outcomes of traditional treatment methods of lateral epicondylitis are variable because of poor tendon healing properties secondary to poor vascularization. Platelet rich plasma provides locally high concentration of growth factors and have shown its efficacy in many tendinopathies and wound healing. We tried to measure the efficacy of locally injected autologous PRP, subjectively by functional oxford elbow score and pain score as well as objectively by ultrasonographic evaluation of the morphologic changes (focal hypoechoic, odema, tendon thickness, fraying, tear, cortical erosion, calcification) in common extensor origin in 30 patients with mean age of 39.3 years of recalcitrant lateral epicondylitis. The mean pain VAS Score improved from 7.7 before injection to 1.8 at final follow up i.e. after 6 months post injection. The Oxford elbow score improved from a mean of 19.2 prior to treatment to 41.3 after the injection at final follow. Ultrasonography of the involved elbow showed decrease in focal hypoechoic, decreased edema, improvement in thickness of the tendon and healing of the tear at the origin site. This study confirms that local PRP by supplying growth factors helps to enhance the stromal and mesenchymal stem cell proliferation and increases tendon vascularity and prevents angiofibroblastic degeneration and thus improves tendon repair and healing property by releasing growth factors and increasing vascularity, which can be documented by improved tendon morphology.

show abstract

Abnormal Microvascular Responses in Lateral Epicondylitis

Cited by 46 publications

References 0 publications

Sympathetic and Sensory Innervations Are Heterogeneously Distributed in Relation to the Blood Vessels at the Extensor carpi radialis brevis Muscle Origin of Man

Sympathetic and Sensory Innervations Are Heterogeneously Distributed in Relation to the Blood Vessels at the Extensor carpi radialis brevis Muscle Origin of Man

Lateral Epicondylalgia or Epicondylitis: What's in a Name?

Treatment of lateral epicondylitis with autologous platelet rich plasma injection

Contact Info

Product

Resources

About