الفهرس 
Anatomy Of The Elbow JointOnly 14 pages are availabe for public view
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Abstract
Tennis elbow or also called Lateral epicondylitis was first described in the German literature by Runge in 1873.Ten years later, in 1883, Morrissuggested an association of symptoms with the game of lawn tennis. This association led to the common term of ‘‘tennis elbow’’.
Lateral elbow pain is a relatively common occurrence, affecting between 1% and 3% of the population, usually noted in patients aged between 35 and 50 years. Although originally thought to be associated with the playing of tennis, lateral elbow pain is currently less often associated with that sport.
The etiology seems to be overuse or repetitive stress, often related to an increase in activity of some kind. It is most commonly managed by non operative measures, including medication, bracing, physical therapy, and injection with a variety of corticosteroid preparations.
Originally, an inflammatory process was thought to be the cause of lateral epicondylitis. Researchers believed that partial tearing of the extensor carpi radialis brevis (ECRB) tendon and periosteum of the lateral epicondyle led to an inflammatory response resulting in symptoms.
Although most studies focused on theextensor carpi radialis brevis tendon, the annular ligament, lateral capsule, radial nerve, and several different bands of the extensor digitorum communis have also been implicated as the causative factor of lateral epicondylitis. However, most microscopic studies of excised tissue demonstrate a failure of reparative response in the ECRB tendon, rather than an inflammatory response in any of these associated structures.
The normal ECRB tendon tissue is invaded by immature fibroblasts and nonfunctional vascular buds, with adjacent tissue being disorganized and hypercellular.Nirschl and Ashmancoined the term‘‘angiofibroblastic tendinosis’’ due to this microscopic appearance. As a result of their excellent investigative work, tennis elbow is now thought to be a dysvascular degenerative-type process termed ‘‘tendinosis’’ rather than a tendonitis .
observation wasdescribed as the primary treatment, stating ‘‘spontaneous cure is probable by the end of eight to twelve months.’’Surgery is reserved for patients who fail to respond to an adequate course of nonoperative treatment.
Recent series have also documented the effectiveness of shock wave therapy, platelet-rich plasma, and low-dosethermal ablation devices. Surgical management has usually been effective through a variety of approaches.
Several surgical treatments for lateral epicondylitis were described.Over the years, advances in surgical management have been made with each advance delineating improvedresults with recommended techniques. Many surgical techniques have been described,including percutaneous, open and arthroscopic procedures for the treatmentof refractory lateral epicondylitis.
In 1979, Nirschl reported 1213 clinical elbow cases with 88 open surgical interventions. Their technique included open identification and excision of thetendinosis tissue within the ECRB, and decortication or drilling of the lateral epicondyle to stimulate blood flow. An anatomic repair of the extensor carpi radialis longus (ECRL) and EDC was then performed. In their opinion, the ECRB did not retract due to the close fascial adherence to the ECRL and, therefore, did not require repair.
Percutaneous release performed in the office setting with local anesthetic and the patient prone. A scalpel with a #11 blade is used to make a stab 2
mm anterior to the tip of the epicondyle parallel to the long axis of the humerus. After release of the ECRB, the patient is asked to flex and extend the elbow against resistance while the surgeon feels for a defect at the origin of the ECRB.
Baker et al reported 40 patients withrefractory lateral epicondylitis who underwent arthroscopic debridement of pathologic tissue. A standard medial portal was used for viewing and a superior lateral portal for debriding. Many times, the lateral epicondyle was decorticated with a burr. Several reports of arthroscopic techniques have been published since that initial report by Baker et al, including a long-term follow-up of the initial group. All reports consistently document satisfactory results with the arthroscopic techniques .