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Lateral Epicondylitis Is a Common, Self-limited Diagnosis of Middle Age

Key findings

  • This retrospective study examined elbow radiographs of 28,563 adults
  • Each year of age increased the odds of having calcification of the extensor carpi radialis brevis (ECRB)
  • Both symptomatic and incidental calcifications of the ECRB were predicted by advancing age, the right elbow and Latinx ethnicity
  • The association of age with calcification supports the theory that the pathophysiological changes of lateral epicondylitis persist and accumulate in aging populations even as symptoms resolve

Enthesopathy of the extensor carpi radialis brevis (ECRB) origin—better known as lateral epicondylitis or "tennis elbow"—is commonly associated with radiographic calcifications of the ECRB origin at the lateral epicondyle.

Using data on such calcifications, Stein J. Janssen, MD, PhD, former orthopaedic surgery resident, and Neal C. Chen, MD, chief of the Hand and Arm Center in the Department of Orthopaedic Surgery at Massachusetts General Hospital, and colleagues recently published evidence that lateral epicondylitis is a common, self-limited diagnosis of middle age. Their report appears in The Archives of Bone and Joint Surgery.

Subjects Details

From the patient registry of two tertiary care hospitals, the research team identified 28,563 adults who had an elbow radiograph with at least two views between January 1, 2005, and January 1, 2015. The average patient age was 50.

Primary Outcome

The primary outcome measure was calcifications of the ECRB. These were reported for 1,178 patients (4.1%).

Independent predictors of calcifications were:

  • Age (OR, 1.04; 4% increase in likelihood per year)
  • Radiograph ordered for atraumatic elbow pain (OR, 2.6)
  • Radiograph ordered for lateral epicondylitis (OR, 5.5)
  • Latinx ethnicity (OR, 1.5)

Secondary Outcome

The secondary outcome measure was incidental (non-symptomatic) calcifications of the ECRB, studied in 17,887 patients whose radiographs were ordered for some reason other than assessing lateral epicondylitis or atraumatic elbow pain. 486 of those patients (2.7%) had incidental calcifications.

Independent predictors of incidental calcifications were:

  • Age (OR, 1.03; 3% increase in likelihood per year)
  • Latinx ethnicity (OR, 1.5)

For both outcomes, the left elbow was significantly less likely than the right elbow to have calcifications of the ECRB. The researchers suspect the associations with Latinx ethnicity are spurious because most patients studied were white.

Persistent and Cumulative

Symptomatic and incidental calcifications peaked in prevalence when patients were 60 to 80 years of age. By age 60, about 9% of the cohort had calcifications of the ECRB.

A previous study in the Journal of Shoulder and Elbow Surgery found that advancing age was independently associated with changes of the ECRB on MRI, which are probably detected even more often than calcifications on radiographs. Patients can be counseled that the evidence to date suggests lateral epicondylitis is common and self-limiting.

prevalence of calcifications of the extensor carpi radialis brevis by age 60

increase per year after age 18 in likelihood of calcifications of the extensor carpi radialis brevis

increase per year after age 18 in likelihood of non-symptomatic calcifications of the extensor carpi radialis brevis

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