Expression of neuropeptides and cytokines at the extensor carpi radialis brevis muscle origin

Repetitive low‐energy shock wave application without local anesthesia is more efficient than repetitive low‐energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis

“…Lately it has become evident that neuropeptides may play a role in insertional tendonitis [2,30,42,57]. Most recently, Ljung et al [3 11 demonstrated findings of a general (PGP 9.5) as well as a sensory innervation (substance P, CGRP) of the tendon-bone junction in subjects suffering from symptomatic lateral epicondylitis.…”

A new integrative model of lateral epicondylalgia: Figure 1

“…A continuum of tendon cellular and structural changes has been recently proposed to occur in tendinopathy, accounting for heterogeneity of presentation 22. Neovessel ingrowth has recently received increased attention as a source of pain in LE, owing to the close association between neural structures, microvasculature and neurochemicals at the proximal tendinous insertion of extensor carpi radialis brevis (ECRB) 23 – 25…”

The Basic Science of Lateral Epicondylosis: Update for the Future

“…Their findings suggested such a link that might promote inflammation and stimulate proliferation and matrix synthesis of fibroblasts, contributing to the pathology of tennis elbow. 31 Ljung and associates conducted a similar study, but they also looked at patients suffering from medial epicondylalgia. As with the previous study, by using immunohistochemistry and antibodies to neurokinin 1-receptors, the distribution of this receptor was studied at the ECRB insertion to the lateral epicondyle.…”

“…Looking at their cross section, collagen fibers from the tendinotic area have a variable diameter, with an uneven mixture of thick and thin fibrils. 10 Uchio et al (2002) purposed that neuropeptides and cytokines such as substance P, calcitonin gene-related peptide, interleukin 1␣, and transforming growth factor ␤ 1 are found at the origin of the ECRB muscle affected the pathogenesis of lateral epicondylosis. Utilizing immunohistochemistry on biopsies of 10 elbows (9 patients) they found nerve fibers around small vessels for substance P-like immunoreactivity or CGRP-like immunoreactivity as well as IL-1␣ and TGF-␤ 1.…”