[Pathogenesis of insertion tendinitis of the elbow in insurance medicine]

The pathogenesis of insertion tendinosis of the elbow,--lateral as well as medial epicondylitis--is difficult to define precisely. Different hypotheses have been postulated with a correspondingly large number of alternative therapeutic proposals. At first view, the prime factor may be a repetitive stress of the groups of muscles involved, respectively of the extensors of the hand and the wrist. In fact, the etiology is multifactorial and includes a cluster of causes. A series of 661 cases of insertion tendinosis of the elbow--lateral and medial epicondylitis--seen over 16 years in a private outpatients-practice for either conservative or operative treatment has been analysed in groups sorted by age, profession, and association with other inflammatory or degenerative changes in the superior limbs. The accumulation of cases in the preclimacteric age (4th decade)--in male as well as in female patients--, and the increased frequency of association with other inflammatory or degenerative changes of the superior limbs (34%), shows the important role of age and constitution. In a smaller series of 289 cases, the subjective causes mentioned by the patients for being the source of their troubles were recorded. These dealt with different areas, such as various professional activities (whether manual labor or not), household work, practising certain sports, leisure time activities (e.g., handicrafts, gardening, needle work), and sometimes as a consequence of trauma. From the medical insurance point of view it results from these observations that the occupational factor alone practically never reaches the 75% causal level required by law in Switzerland for considering lateral or medial epicondylitis as an occupational disease. Likewise, an acceptance as a sequel of an accident is only exceptionally possible, as far as major tissue damages have been proved.