Microscopic histopathology of chronic refractory lateral epicondylitis

Abstract

The histopathologic features from 11 patients who were treated surgically for lateral epicondylitis were graded and compared to similar tissue from 12 cadaveric specimens. All studies were done by a single pathologist who had no knowledge of the origin of the specimen. The surgical specimens were interpreted as abnormal in all 11 specimens, and all 12 of the control specimens were reported as being without histologic abnormality. Vascular proliferation was present in 10 of 11 and focal hyaline degeneration was recorded in all 11 of the surgical specimens. Neither feature was present in any of the control material (P < 0.001). These data suggest that chronic refractory lateral epicondylitis requiring surgery is a degenerative rather than inflammatory process. This may account for the lack of response to rest and antiinflammatory medication.

Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

“…The ECRB origin is the commonly accepted source of disease [10,29]. Other structures such as the annular ligament and lateral capsule also might be causative factors of lateral epicondylitis.…”

“…Various authors have attributed the cause to other conditions including bursitis [21], synovitis [20], and degenerative arthritis [28]. In addition, the extensor carpi radialis brevis (ECRB) origin is the commonly noted source of disease [10,29]. Other structures such as the annular ligament and lateral capsule also might be causative factors of lateral epicondylitis.…”

“…New treatment modalities for refractory lateral epicondylitis such as platelet-rich plasma [12], Botox 1 (Allergan Inc, Irvine, CA, USA) [15], or extracorporeal shock wave therapy [17] reportedly are associated with 61% improvement at 6 weeks, 65% good to excellent results at 1 year, and 73% good to excellent results at 6 months after treatment, respectively; however, none of these treatments have shown superiority over surgical débridement. Furthermore, the pathologic features of epicondylitis and etiology of the condition are not completely understood [10,18,29].…”

Mechanical solution for a mechanical problem: Tennis elbow

“…Many of the approaches to treatment of lateral epicondylitis seem to be predicated on the subsequently falsified hypothesis that the epicondylitis represented an inflammatory process [3][4][5][6][7][8][9] . These attempts have included use of oral or topical non-steroidal anti-inflammatory drugs [10][11][12] , injections [13] of corticosteroids [10,[13][14][15][16][17][18][19][20] , anesthetics (e.g., bupivacaine) [21] or even botulinum toxin [22] injection, none of which have had documented long-term clinical benefit [3] .…”

“…Microscopic examination actually reveals angiofibroblastic and mucoid degeneration, attributed to mechanical overloading [3] . Indeed, ultrasound evaluation reveals me-chanical damage to tendons [6][7][8][9] .…”