Introduction

Elbow tendinopathy is a common overuse injury involving the tendons that attach to the humeral epicondyles.  The 2 main types are lateral epicondylitis, which involves the wrist extensor tendons, and medial epicondylitis, which involves the flexor-pronator tendons.

Pathogenesis and risk factors

Elbow tendinopathy is primarily a degenerative, instead of an inflammatory, process.  Repetitive, forceful use of the wrist extensor or flexor muscles can lead to microtrauma at the tendon origin.  This results in angiofibroblastic tendinosis, a degenerative process marked by excess fibroblasts, disorganized collagen, and neovascularization without a significant inflammatory infiltrate.  Tendinosis weakens the tendon-bone junction and leads to pain, swelling, and functional impairment ( Figure 1).  Therefore, common risk factors include a sudden increase in activity level, poor athletic technique or ergonomics, and smoking and obesity (which are linked to poor tendon healing).

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Figures

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Images

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Tables

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