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

Examination of a large number (1232) of elbows from skeletal specimens reve aled that 16% displayed a characteristic pattern of bone formation exactly underlying the area of exquisite point tenderness at the lateral humeral ep icondyle 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 elbo w approaches. In a group of clinical cases of tennis elbow (20 patients), s imilar bony changes could be demonstrated in the majority (60%) of patients with chronic tennis elbow symptoms by the use of specialized x-ray techniq ues-most notably, coronal reconstructions with computed axial tomography. T en cadaver specimens were also dissected to delineate the muscular and caps ulotendinous insertions in this area. We call attention to these bony chang es in the supposition that they may be involved in the development and pers istence of symptoms in tennis elbow.