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

Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis.Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation.Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not.Conclusions. Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.

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Additional Muscle Belly and Abberant Muscle Fibers over the Extensor Retinaculam of Wrist

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1708625 ◽

2016 ◽

Vol 06 (01) ◽

pp. 085-087

Author(s):

Divia Paul A. ◽

Manisha Rajanand Gaikwad

Keyword(s):

Muscle Fibres ◽

Nerve Supply ◽

Present Case Report ◽

Muscle Belly ◽

Lateral Epicondyle ◽

Left Hand ◽

Male Cadaver ◽

Extensor Compartment ◽

Extensor Carpi Radialis ◽

Indian Male

AbstractVariations in the extensor compartment of forearm are common and are significant to neurologists, surgeons and anatomists. The present case report describes a well-developed muscle belly medial to the tendons of extensor carpi radialis longus and extensor carpi radialis brevis. Muscle belly is originating from common extensor origin on lateral epicondyle and is inserted to base of third metacarpal; bilaterally. In addition to this, aberrant muscle fibres packed in a common connective tissue bundle over the dorsal digital expansion of left hand were also found. The above observations were noted during routine dissection of a 50 year old Indian male cadaver. The variant muscle having common extensor origin and muscle fibres over dorsal digital expansion were identified and protected. The blood supply and nerve supply were noted. The clinical significance of the variation is explained in detail.

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Effects of Rehearsal Time and Repertoire Speed on Extensor Carpi Radialis EMG in Conservatory Piano Students

Medical Problems of Performing Artists ◽

10.21091/mppa.2020.2013 ◽

2020 ◽

Vol 35 (2) ◽

pp. 81-88

Author(s):

Jean-Pierre Baeyens ◽

Ben Serrien ◽

Maggie Goossens ◽

Katia Veekmans ◽

Regs Baeyens ◽

...

Keyword(s):

Repeated Measures ◽

Lateral Epicondylitis ◽

Mean Amplitude ◽

Frequency Component ◽

Voluntary Contraction ◽

Semg Signal ◽

Piano Etudes ◽

Piano Students ◽

Forearm Muscles ◽

Extensor Carpi Radialis

BACKGROUND: Repetitive actions while playing piano may overload forearm muscles and tendons, leading to playing-related musculoskeletal disorders (PRMDs), including lateral epicondylitis. METHODS: In this pilot study, surface electromyography (sEMG) activity of the extensor carpi radialis (ECR) was captured in 10 conservatory piano students while playing a fast and a slow music score selected from the individual’s repertoire, each 3 minutes long. Measurements were made at baseline and again after 2 hrs and 4 hrs of rehearsal time of the piano études. The amplitude of the sEMG signal was processed by a smoothing algorithm, and the frequency component with a non-orthogonal wavelets procedure. Amplitude of the sEMG was expressed in percent of maximal voluntary contraction (%MVC) at baseline. Statistical analysis encompassed 2-way repeated measures ANOVAs for the amplitude and frequency components of the sEMG signal (a set at 5%). The students also rated the intensity of rehearsals using a VAS. RESULTS: The ECR presented with a mean amplitude of 23%MVC for the slow scores, which increased significantly to 36%MVC for the fast scores. The sEMG signal presented a significant though small decrease of 1.9%MVC in amplitude between baseline and 4 hrs of rehearsal time and no shift in frequency, which may indicate that the rehearsals were held at a physiological steady-state and suggesting optimization or complementary muscle loading. CONCLUSIONS: These data accentuated that the loading of the ECR (as reflected in the amplitude component) was higher than that seen for computer keyboard workers. The augmented loading of the ECR and reduced blood flow to forearm muscles may be a factor in the development of PRMDs in pianists.

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Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis

Hand ◽

10.1177/1558944716668844 ◽

2017 ◽

Vol 12 (3) ◽

pp. NP32-NP36 ◽

Cited By ~ 2

Author(s):

Mihir J. Desai ◽

Hari Ramalingam ◽

David S. Ruch

Keyword(s):

Heterotopic Ossification ◽

Young Athlete ◽

Lateral Epicondylitis ◽

Primary Prophylaxis ◽

Arthroscopic Treatment ◽

Arthroscopic Debridement ◽

Elbow Arthroscopy ◽

First Case ◽

Extensor Carpi Radialis ◽

Final Disposition

Background: Heterotopic ossification (HO) is a well-known complication following the surgical treatment of fractures and dislocations about the elbow but it is not commonly discussed as a complication following arthroscopy. We present a case of a young athlete who developed HO after the arthroscopic treatment of lateral epicondylitis. Methods: This is a case report chart review of a 24 year old male with lateral epicondylitis. After failing conservative measures, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) origin ensued. The treatment and patient’s final disposition were reported. Results: The patient developed heterotopic ossification of the elbow follow arthroscopic debridement of the ECRB origin. Further surgery was required to excise the heterotopic ossification. Good recovery of motion was achieved. Conclusion: To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. As the use of elbow arthroscopy continues to grow, there is a need for identification of the risk factors and primary prophylaxis for HO.

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Anatomic Study of Extensor Carpi Radialis Brevis in Relation to Etiology of Lateral Epicondylitis

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.07.107 ◽

2013 ◽

Vol 29 (10) ◽

pp. e96-e97

Author(s):

Akimoto Nimura ◽

Tomoyuki Mochizuki ◽

Hiroyuki Sugaya ◽

Takeshi Muneta ◽

Keiichi Akita

Keyword(s):

Lateral Epicondylitis ◽

Anatomic Study ◽

Extensor Carpi Radialis

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Supplementary Comment on “Investigation of Two Possible Compression Sites of the Deep Branch of the Radial Nerve and Nerve Supply of the Extensor Carpi Radialis Brevis Muscle”

Neurologia medico-chirurgica ◽

10.2176/nmc.44.102b ◽

2004 ◽

Vol 44 (2) ◽

pp. 102b

Author(s):

Ernst Heinrich GROTE

Keyword(s):

Radial Nerve ◽

Nerve Supply ◽

Deep Branch ◽

Extensor Carpi Radialis

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Extensor Carpi Radialis brevis: Review of Anatomy and Clinical Significance to Orthopedics

Orthopaedics and Surgical Sports Medicine ◽

10.31579/2641-0427/017 ◽

2019 ◽

Vol 2 (1) ◽

pp. 01-08

Author(s):

Jennifer L Smith ◽

Jacob B Stirton ◽

Nabil A Ebraheim

Keyword(s):

Clinical Significance ◽

Radial Nerve ◽

Lateral Epicondylitis ◽

Extensor Digitorum ◽

Surgical Approaches ◽

Extensor Digitorum Communis ◽

Lateral Epicondyle ◽

The Third ◽

Proper Management ◽

Extensor Carpi Radialis

The extensor carpi radialis brevis (ECRB) muscle is an integral extensor and abductor of the wrist. It originates from the lateral epicondyle of the humerus, laying deep to the extensor carpi radialis longus and extensor digitorum communis, and superficial to the supinator. Insertion occurs at the base of the third metacarpal. The radial nerve or a derivative supplies innervation. Its significance in orthopedics is highlighted by its involvement in multiple surgical approaches, such as the Thompson and Kaplan approaches for exposure of the radius, as well as its association with several routinely observed pathologies. Many of the associated syndromes, such as lateral epicondylitis, arise from repetitive gripping motions or overuse and are frequently seen in the orthopedic clinic. This review seeks to provide a comprehensive summary of the relevance of the ECRB to the orthopedic setting to broaden knowledge of its anatomy and increase recognition and proper management of associated pathologies.

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Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2010.02.008 ◽

2010 ◽

Vol 19 (5) ◽

pp. 651-656 ◽

Cited By ~ 79

Author(s):

Christian Lattermann ◽

Anthony A. Romeo ◽

Ammar Anbari ◽

Alexander K. Meininger ◽

L. Pearce McCarty ◽

...

Keyword(s):

Lateral Epicondylitis ◽

Arthroscopic Debridement ◽

Extensor Carpi Radialis

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The expression of substance P and calcitonin gene-related peptide is associated with the severity of tendon degeneration in lateral epicondylitis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04067-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Soo-Hong Han ◽

Hyung Kyung Kim ◽

Yoon Jang ◽

Hyeon Hae Lee ◽

Jeongbae Rhie ◽

...

Keyword(s):

Substance P ◽

Histological Analysis ◽

Univariate Analysis ◽

Lateral Epicondylitis ◽

Calcitonin Gene Related Peptide ◽

Tendon Degeneration ◽

Related Peptide ◽

Calcitonin Gene ◽

Vas Scores ◽

Extensor Carpi Radialis

Abstract Background In this study, we investigated whether substance P (SP) or calcitonin gene-related peptide (CGRP) expression is associated with tendon degeneration in patients with lateral epicondylitis. Methods Twenty-nine patients who underwent surgical treatment for lateral epicondylitis were enrolled in the final analyses. Extensor carpi radialis brevis tendon origins were harvested for histological analysis. Results SP and CGRP immunostaining were negative in healthy tendons but positive in degenerative tendons; moreover, their immunoreactivity increased with degeneration severity. Univariate analysis indicated that variables such as the preoperative visual analog scale (VAS) score or SP or CGRP expression levels were significantly associated with the Movin score. However, multivariate analysis revealed that only higher SP and/or CGRP signals were associated with higher Movin scores. Elevations in SP or CGRP expression were also linked with significantly severe preoperative VAS scores. Conclusion We demonstrated that tendon degeneration severity is associated with increased SP and CGRP expression in the biopsy samples of lateral epicondylitis.

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Lateral Epicondylitis: Current Concept

Clinics in Shoulder and Elbow ◽

10.5397/cise.2014.17.3.138 ◽

2014 ◽

Vol 17 (3) ◽

pp. 138-144 ◽

Cited By ~ 1

Author(s):

In Ho Jeon ◽

Aashay Laxmikant Kekatpure ◽

Ji Ho Sun ◽

Kyeong Bo Shim ◽

Sung Hoon Choi ◽

...

Keyword(s):

Conservative Treatment ◽

Operative Treatment ◽

Prospective Studies ◽

Lateral Epicondylitis ◽

Nonoperative Treatment ◽

Functional Restoration ◽

Current Concept ◽

Common Causes ◽

High Degree ◽

Extensor Carpi Radialis

Lateral epicondylitis is one of the most common causes of elbow pain and has been known to be caused by degeneration of the extensor carpi radialis brevis (ECRB). Nonoperative treatment should be tried first in all patients, because it has been deemed highly successful; however only few prospective studies suggest that symptoms frequently was completely resolved. Operative treatment is indicated for recalcitrant pain after failed conservative treatment, which involves excision of the pathologic portion of the ECRB and results in a high degree of subjective relief and functional restoration. We will review the pathology of the lateral epicondylitis and operative and nonoperative treatment of lateral epicondylitis.

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