Bony changes at the lateral epicondyle of possible significance in tennis elbow syndrome

Examination of a large number (1232) of elbows from skeletal specimens revealed that 16% displayed a characteristic pattern of bone formation exactly underlying the area of exquisite point tenderness at the lateral humeral epicondyle found in clinical cases of tennis elbow. These changes are usually not seen on standard roentgenograms and can be missed, even at the time of surgery, because this area is not commonly exposed in standard tennis elbow approaches. In a group of clinical cases of tennis elbow (20 patients), similar bony changes could be demonstrated in the majority (60%) of patients with chronic tennis elbow symptoms by the use of specialized x-ray techniques-most notably, coronal reconstructions with computed axial tomography. Ten cadaver specimens were also dissected to delineate the muscular and capsulotendinous insertions in this area. We call attention to these bony changes in the supposition that they may be involved in the development and persistence of symptoms in tennis elbow.