Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis

Abstract

Lateral epicondylitis (LE) or tennis elbow has been the subject of concern during the last 60 years, but the pathogenesis of the LE remains unclear. The LE can be due to the tendinogenic, articular or neurogenic reasons. Numerous theories have been put fourth in the recent past, out of which one of the most popular theories is that the condition results from repeated contraction of the wrist extensor muscles, especially the extensor carpi radialis brevis (ECRB) which may compress the posterior branch of the radial nerve (PBRN) at the elbow during pronation. We studied 72 upper limbs (36 formalin-fixed cadaver) for the origin, nerve supply and the course of PBRN in relation to the ECRB as one of the goal for the present study. The possible presence of an arch of the ECRB around the PBRN was also observed and recorded. The nerve to ECRB was a branch from the radial nerve in 11 cases (15.2%); from the PBRN in 36 cases (50%) and from the superficial branch of the radial nerve in 25 cases (34.7%), respectively. The ECRB had a tendinous arch in 21 cases (29.1%); a muscular arch in 8 (11.1%) cases and the arch was absent in 43 cases (59.7%). When the ECRB had a tendinous or muscular arch around the PBRN, it may compress the same and this condition may worsen during the repeated supination and pronation as observed in tennis and cricket players. The presence of such tendinous or muscular arch should be considered by orthopedicians and neurosurgeons, while releasing the PBRN during LE surgery.

A Morphological Study of Plantaris Muscle and Its Surgical Perspective

“…When referring to previous authors like Daseler and Anson in 1943 [21] and Schlicht S M in 1992 [26] showed that in at least 80% of their dissected lower limbs the insertion of the plantaris tendon is directly inserted to the calcaneus independent of the tendocalcaneus. In a study conducted by Nayak et al in 2010 on 52 lower limbs of 26 males have observed 36.53% of insertions of the plantaris muscle were independently to the calcaneum [27]. The standard text books like Hollinshead 1958 and Gray's Anatomy 40 th Edn 2008 have mentioned the length of the muscle belly is 7-10cm.…”

Mets and oscillating energy manual therapy in chronic lateral epicondylosis: a comparative study.

“…In any rehabilitation of the upper limbs, complete recovery must be achieved; if not, it can limit the quality of life and functional independence. (Nayak et al, 2010) Lateral epicondylosis can be due to tendinogenic, articular, or neurogenic causes. Several theories have been laid down, and the most recent theory suggests that compression of posterior branch of the radial nerve at the elbow occurs during the repeated actions of the wrist extensor muscles, especially the extensor carpi radialis (Bunata, 2007)examined the anatomic factors related to the causes of lateral epicondylosis.…”

Tennis Elbow in Athletes: More Than Just Tennis?

“…Repetitive abrasion through the arc of motion could help explain the wide variety of sporting and occupational associations. A neurogenic cause of these symptoms has also been proposed based on the anatomy of nerve innervation to the ECRB [8]. In a cadaver study, 40.2 % of specimens had either a muscular or tendinous arch around the posterior branch of the radial nerve, which the authors proposed as a potential cause of tennis elbow symptoms.…”

“…Cricket also has a small footprint on the lateral epicondylitis literature and receives only passing mention [8]. Unlike baseball, a cricket batsman remains at bat until retired and may be required to swing many more times than a baseball player in a match.…”