Current concept
Elbow Tendinopathy and Tendon Ruptures: Epicondylitis, Biceps and Triceps Ruptures

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Lateral and medial epicondylitis are common causes of elbow pain in the general population, with the lateral variety being more common than the medial by a ratio reportedly ranging from 4:1 to 7:1. Initially thought to be an inflammatory condition, epicondylitis has ultimately been shown to result from tendinous microtearing followed by an incomplete reparative response. Numerous nonoperative and operative treatment options have been employed in the treatment of epicondylitis, without the emergence of a single, consistent, universally accepted treatment protocol.

Tendon ruptures about the elbow are much less frequent, but result in more significant disability and loss of function. Distal biceps tendon ruptures typically occur in middle-aged males as a result of an event that causes a sudden, eccentric contraction of the biceps. Triceps tendon ruptures are exceedingly rare but usually have a similar etiology with a forceful eccentric contraction of the triceps that causes avulsion of the tendon from the olecranon. The diagnosis of these injuries is not always readily made. Complete ruptures of the biceps or triceps tendons have traditionally been treated surgically with good results. With regard to biceps ruptures, there continues to be debate about the best surgical approach, as well as the best method of fixation of tendon to bone.

This article is not meant to be an exhaustive review of the broad topics of elbow tendinopathy and tendon ruptures, but rather is a review of recently published information on the topics that will assist the clinician in diagnosis and management of these conditions.

Section snippets

Diagnosis

Patients with lateral epicondylitis typically have burning rather than mechanical pain, pain with resisted wrist extension, pain with reaching out to lift, and greater pain with the elbow extended than flexed. Dorf et al. showed that the measurement of extension grip strength is a useful objective tool to aid in the diagnosis of lateral epicondylitis.2 In their study, the affected arm averaged 50% of the strength of the healthy arm in extension and 69% of the strength of the healthy arm in

Diagnosis

The clinical diagnosis of biceps tendon rupture is, unfortunately, often initially missed. Several investigators have thus sought to develop simple, accurate physical examination tests to expedite surgical referral. Ruland et al., using the Thompson test for Achilles tendon rupture as a model, developed the biceps squeeze test to assess the integrity of the distal biceps tendon.32 The biceps muscle belly is squeezed to see if it elicits forearm supination. The sensitivity of the test was 96%

Triceps Tendon Ruptures

Similar to diagnosis of biceps tendon ruptures, the diagnosis of triceps tendon ruptures is often delayed. In the series of van Riet et al., 10 of 23 triceps ruptures were initially misdiagnosed.60 Signs and symptoms of triceps rupture include posterior elbow pain, swelling, triceps weakness, and a palpable defect in the tendon. Plain radiographs occasionally show calcification in the tendon or a small bony fleck off the olecranon (Fig. 3). MRI can confirm the diagnosis and differentiate

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