Lateral epicondylitis: Are we missing out on radial nerve involvement? A cross-sectional study

Abstract

Introduction: Lateral epicondylitis (LE) is a common ailment causing pain and functional limitations. There is an inadequate understanding of its etiopathogenesis. Involvement of the radial nerve (RN) as the primary causative factor for this condition remains debatable. The aim of the present study was to assess the RN thickness in patients with LE and compare it with the unaffected side.

Methods: The study included seventy eligible patients (M:F, 22:48) in the age group of 30-60 years with a clinical diagnosis of LE. The cross-sectional area of RN was measured at the spiral groove (SG) and around the antecubital fossa (AF) using ultrasound and compared with the unaffected side. Numeric Pain Rating Scale (NPRS) and the QuickDASH scale were used to assess pain and functional impairment.

Results: Thickness of RN at the AF (p = 0.026) and the SG (p = 0.0117) on the affected were statistically significant compared to the unaffected side in the cohort comprising of all the 70 patients. Out of 70 patients, increased thickness was seen in 23 at the SG and 19 at the AF. QuickDASH was statistically significant in patients who had thickened nerves compared to the unaffected side at the SG (p = 0.04) but not at the AF (p = 0.16). NPRS was not statistically significant at either the AF (p = 0.34) or the SG (p = 0.71) in patients with thickened nerves.

Conclusion: Tennis elbow needs to be no longer acknowledged only as tendinopathy. It also requires consideration of the involvement of the RN.

Keywords: Functional impairment; Pain; Radial nerve; Tennis elbow; Ultrasound.