This current concepts review examines the true nature of lateral tennis elbow. The authors studied nine operative specimens using histology, immunohistochemistry, and electron microscopy, comparing them with ten cadaveric controls. Their question: is tennis elbow an inflammatory tendinitis or a degenerative tendinosis, and what should that mean for treatment?
When you see chronic lateral elbow pain, stop thinking inflammation and start thinking failed degenerative healing. This paper cements that tennis elbow is tendinosis at the ECRB origin, defined by angiofibroblastic hyperplasia with no meaningful inflammatory cells. That single reframe changes management.
Anti-inflammatory measures target a process that is not there. Steroids buy short-term pain relief but do nothing at 3 months or a year, and repeated injections are linked to matrix damage and rupture. Use them sparingly, only to let a patient participate in rehab.
Because the failure is in collagen cross-linking and remodeling, the treatment that actually helps is a graded resistance-based exercise program that delivers cyclical tensile load. Immobilization weakens tendon and is counterproductive.
Reserve surgery for patients who fail a structured three-month program. The operation works by resecting the dull, gray, soft pathologic tissue and inducing bleeding to convert a stalled intrinsic response into an extrinsic healing one.
This current concepts review examines the true nature of lateral tennis elbow. The authors studied nine operative specimens using histology, immunohistochemistry, and electron microscopy, comparing them with ten cadaveric controls. Their question: is tennis elbow an inflammatory tendinitis or a degenerative tendinosis, and what should that mean for treatment?
When you see chronic lateral elbow pain, stop thinking inflammation and start thinking failed degenerative healing. This paper cements that tennis elbow is tendinosis at the ECRB origin, defined by angiofibroblastic hyperplasia with no meaningful inflammatory cells. That single reframe changes management.
Anti-inflammatory measures target a process that is not there. Steroids buy short-term pain relief but do nothing at 3 months or a year, and repeated injections are linked to matrix damage and rupture. Use them sparingly, only to let a patient participate in rehab.
Because the failure is in collagen cross-linking and remodeling, the treatment that actually helps is a graded resistance-based exercise program that delivers cyclical tensile load. Immobilization weakens tendon and is counterproductive.
Reserve surgery for patients who fail a structured three-month program. The operation works by resecting the dull, gray, soft pathologic tissue and inducing bleeding to convert a stalled intrinsic response into an extrinsic healing one.