Open Access Open Access  Restricted Access Subscription Access
Cover Image

Tennis elbow, is it inflammation? - Histopathological characteristics of epicondylitis

Eugene Kim, Jai Hyung Park, Dong-Hoon Kim, Byeong Ryong Han, Seunghee Lee


Aim: Angiofibroblastic hyperplasia was previously found to be the main histological characteristic of epicondylitis. Anti-inflammatory agents are widely used for conservative management of epicondylitis, and appear to be effective. We aim to analyze the histopathological features of epicondylitis in more detail and determine whether inflammatory features exist, and re-evaluate the previous study by a new dying technique.

Materials and methods: Surgical specimens were stained by hematoxylin and eosin(H&E) stain for histological analysis, and Masson’s trichrome stain was added to assess collagenous degeneration. those, according to The histopathological observations from these stains (fibroblastic proliferation, vascular proliferation, hyaline degeneration, inflammatory cellular infiltration, calcific deposits) in patients diagnosed as having epicondylitis of elbow that was refractory to conservative treatment were classified.

Results: All specimens present high grade fibroblastic proliferation (Grades 2-3), and vascular proliferation, hyaline degeneration, and calcific deposition are common features of the surgical specimens (Grades 1-3). But, inflammatory cellular infiltration is rare (2 of 11), and low grade (Grade1).

Conclusion: The main histopathological features of chronic refractory epicondylitis of elbow are degenerative changes including fibroblastic proliferation and vascular proliferation, and inflammatory changes are rare. We suggest that anti-inflammatory agents have limitations for the treatment of chronic refractory epicondylitis.



Tennis elbow; histology; inflammation; hyperplasia

Full Text:



Jobe FW, Ciccotti MG., 1994. Lateral and Medial Epicondylitis of the Elbow. J Am Acad Orthop Surg. 2, 1-8.

Greco S, Nellans KW, Levine WN., 2009. Lateral epicondylitis: open versus arthroscopic. Operative Techniques in Orthopaedics. 19, 228-34.

Nirschl RP, Pettrone FA., 1979. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 61, 832-9.

Kraushaar BS, Nirschl RP., 1999. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 81, 259-78.

Goldner J., 1938. A modification of the Masson trichrome technique for routine laboratory purposes. The American journal of pathology. 14, 237.

Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T., 2013. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline a randomized, double-blind, placebo-controlled trial. The American journal of sports medicine. 41, 625-35.

Coonrad RW, Hooper WR., 1973. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am. 55, 1177-82.

Alfredson H, Ljung B-O, Thorsen K, Lorentzon R., 2000. In vivo investigation of ECRB tendons with microdialysis technique--no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthopaedica Scandinavica. 71, 475-9.

Bales CP, Placzek JD, Malone KJ, Vaupel Z, Arnoczky SP., 2007. Microvascular supply of the lateral epicondyle and common extensor origin. Journal of Shoulder and Elbow Surgery. 16, 497-501.

Chen J, Wang A, Xu J, Zheng M., 2010. In chronic lateral epicondylitis, apoptosis and autophagic cell death occur in the extensor carpi radialis brevis tendon. Journal of Shoulder and Elbow Surgery. 19, 355-62.

Pitzer ME, Seidenberg PH, Bader DA., 2014. Elbow tendinopathy. Medical Clinics of North America. 98, 833-49.

Ciccotti MG, Ramani MN., 2003. Medial epicondylitis. Techniques in hand & upper extremity surgery. 7, 190-6.

Nirschl RP, Ashman ES., 2003. Elbow tendinopathy: tennis elbow. Clinics in sports medicine. 22, 813-36.

Hart LE., 2002. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis? Clinical Journal of Sport Medicine. 12, 403-4.

Hay EM, Paterson SM, Lewis M, Hosie G, Croft P., 1999. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. Bmj. 319, 964-8.


  • There are currently no refbacks.