• The Korean Journal of Pain
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• v.7 no.1
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• pp.34-38
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• 1994

The common disorder called tennis elbow exhibits typical clinical characteristics, i.e. painful condition at the lateral aspect of elbow joint on resisted wrist extension. However an exact cause for this painful condition has not yet been established. Many observers believe that the usual lesion of tennis elbow is a partial rupture of the extensor tendon at the tenoperiosteal juction on the lateral epicondyle of humerus. However the mechanism of the tendon rupture has never been explained. Conservative treatments on the tender area have been the most common therapeutic modalities for pain relief of tennis elbow. Based on my clinical experiences and anatomical studies, I discerned that tennis elbow is a periostitis of lateral epicondyle of humerus secondary to spastic contraction of muscular belly of extensor carpi radialis after over-stretched injury. Therefore, spasmolytic treatment on the extensor carpi radialis muscle provided a favorable result for permanent relief for tennis elbow pain.

• Journal of Mechanical Science and Technology
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• v.18 no.4
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• pp.582-591
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• 2004

The purpose of this study was to determine the effects of elbow joint angle on mechanical properties, as represented by ultimate load, failure strain and elastic modulus, of bone-tendon specimens of common extensor tendon of the humeral epicondyle. Eight pairs of specimens were equally divided into two groups of 8 each, which selected arbitrarily from left or right side of each pair, positioned at 45$^{\circ}$ and 90$^{\circ}$ of elbow flexion and subjected to tension to failure in the physiological direction of the common extensor tendon. For comparison of the differences in the failure and elastic modulus between tendon and the bone-junction, data for both were evaluated individually. Significant reduction in ultimate load of bone-tendon specimens was shown to occur at 45$^{\circ}$. The values obtained from the bone-tendon junctions with regard to the failure strain were significant higher than those from tendon in both loading directions, but the largest failure strain at the bone-tendon junction was found at 45$^{\circ}$. The elastic modulus was found to decrease significantly at the bone-tendon junction when the loading direction switched from 90$^{\circ}$ to 45$^{\circ}$. Histological observation, after mechanical tensile tests, in both loading directions showed that failure occurred at the interface between tendon and uncalcified fibrocartilage in the thinnest fibrocartilage zone of the bone-tendon junction. We concluded that differences in measured mechanical properties are a consequence of varying the loading direction of the tendon across the bone-tendon specimen.

• Journal of Mechanical Science and Technology
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• v.15 no.7
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• pp.1013-1021
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• 2001

A series of rabbit common extensor tendon specimens of the humeral epicondyle were subjected to tensile tests under two displacement rates (100mm/min and 10mm/min) and different elbow flexion positions 45°, 90°and 135°. Biomechanical properties of ultimate tensile strength, failure strain, energy absorption and stiffness of the bone-tendon specimen were determined. Statistically significant differences were found in ultimate tensile strength, failure strain, energy absorption and stiffness of bone-tendon specimens as a consequence of different elbow flexion angles and displacement rates. The results indicated that the bone-tendon specimens at the 45°elbow flexion had the lowest ultimate tensile strength; this flexion angle also had the highest failure strain and the lowest stiffness compared to other elbow flexion positions. In comparing the data from two displacement rates, bone-tendon specimens had lower ultimate tensile strength at all flexion angles when tested at the 10mm/min displacement rate. These results indicate that creep damage occurred during the slow displacement rate. The major failure mode of bone-tendon specimens during tensile testing changed from 100% of midsubstance failure at the 90°and 135°elbow flexion to 40% of bone-tendon origin failure at 45°. We conclude that failure mechanics of the bone-tendon unit of the lateral epicondyle are substantially affected by loading direction and displacement rate.

• Journal of Biomedical Engineering Research
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• v.19 no.4
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• pp.393-401
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• 1998

Based on clinical observations, it is suspected that the bone-tendon origin is the site where piratical failure, leading to pathophysiological changes in the humeral epicondyle after repetitive loading, is initiated Mechanical properties and failure patterns of the common extensor and flexor tendons of the humeral epicondyle under static and repetitive loading have not been well documented. Our goal was to determine mechanical properties of failure strength and strain changes, to correlate strain changes and the number of cyclic repetitions, and to identify the failure pattern of bone-tendon specimens of common extensor and flexor tendons of the humeral epicondyle. Mechnaical properties of human cadaver bone-tendon specimens of the common extensor and flexor tendons of the humeral epicondyle were tested under two different loading rates. No statistically significant difference in ultimate tensile strength was found between male and female specimens or between slow (10 mm/sec) and fast elongation (100 mm/sec) rates. However, a statistically significant difference in ultimate tensile strength between the common extensor (1190.0 N/$cm^2{\pm}$388.8) and flexor 1922.0 N/$cm^2{\pm}$764.4)tendons was found (p<0.05). When loads of 25%, 33%, and 41% of the ultimate tensile strength of their contralateral sides were applied, the number of cycles required to reach 24% strain change for the common extersor and flexor tendons were approximately 8,893, 1,907, and 410, respectively. The relationship between cycles and loads was correlated ($R^2$=0.46) Histological observation showed that complete or partial failure after tensile or cyclic loadings occurred at the transitional zone, which is the uncalcified fibrocartilage zone between tendon and bone of the humeral epicondyle. Sequential histological sections revealed that failure initiated at the upper, medial aspect of the extensor carpi radialis brevis tendon origin. Biomechanical and hstological data obtained in this study indicated that the uncalcified fibrocartilage zone at the bone-tendon origin of the common extensor and flexor tendons is the weak anatomical structure of the humeral epicondyle.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.84-88
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• 2011

Purpose: We report here on two cases of calcific tendinitis at the origin of the common extensor tendons of the forearm. Materials and Methods: A 42 year-old female complained of left elbow pain and flexion contracture. After obtaining the simple radiographs and MRI, surgical excision of the calcific deposits was done under the diagnosis of calcific tendinitis. A 25 year-old female complained of right elbow pain and a limited range of motion. Simple radiographs showed a calcific deposit just distal to the lateral epicondyle, and then she was managed with extracorporeal shock wave therapy. Results: The pain disappeared completely and both patients regained a full range of motion after treatments. Conclusion: Calcific tendinitis at the origin of the common extensor tendons of the forearm should be included in the differential diagnosis of the lateral elbow diseases that cause pain and a limited range of motion.

• The Journal of Korean Medicine
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• v.39 no.4
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• pp.121-125
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• 2018

Objectives: This study was carried out to analyse Hand Greater Yang Skin in human. Methods: Hand Greater Yang meridian was labeled with latex in the body surface of the cadaver. And subsequently body among superficial fascia and muscular layer were dissected in order to observe internal structures. Results : A depth of Skin encompasses a common integument and a immediately below superficial fascia, this study established Skin boundary with adjacent structures such as relative muscle, tendon as compass. The Skin area of the Hand Greater Yang in human are as follows: The skin close to 0.1chon ulnad of $5^{th}$ nail angle, ulnad base of $5^{th}$ phalanx, ulnad head of $5^{th}$ metacapus(relevant muscle: abductor digiti minimi muscle), ulnad of hamate, tip of ulnar styloid process(extensor carpi ulnaris tendon), radiad of ulnar styloid process, 2cm below midpoint between Sohae and Yanggok(extensor carpi ulnaris), between medial epicondyle of humerus and olecranon of ulnar(ulnar nerve), The skin close to deltoid muscle, trapezius muscle, platysma muscle, inner muscles such as teres major muscle, infraspinatus muscle, supraspinatus muscle, levator scapulae muscle, splenius cervicis muscle, splenius capitis muscle, sternocleidomastoid muscle, digastric muscle, stylohyoid muscle, zygomaticus major muscle, auricularis anterior muscle. Conclusions: The Skin area of the Hand Greater Yang from the anatomical viewpoint seems to be the skin area outside the superficial fascia or muscles involved in the pathway of Hand Greater Yang meridian, collateral meridian, meridian muscle, with the condition that we consider adjacent skins.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.49-54
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• 2023

Background: Lateral epicondylitis is an increasingly debilitating condition in working population. Evidence for conservative treatment modalities has been inconclusive. Percutaneous pie crusting of the common extensor origin at the lateral epicondyle at the time of local corticosteroid injection (CSI) has been proposed sparsely. The objective of this study was to analyze if concomitant CSI and pie-crusting of the common extensor origin provides better outcome than CSI alone in lateral epicondylitis. Methods: This case-control study on 236 patients was conducted at a single center between January 1, 2020, and May 31, 2022. Patients were divided into two groups (n=118 each) based on their preference. Group A underwent CSI alone and group B underwent pie crusting along with CSI. The clinical and functional outcomes of all patients were evaluated at 2, 4, 6, and 12-week post-procedure using the visual analog scale (VAS) and Nirschl score. The mean time for return to daily activities was also compared. Results: Both groups showed significant improvement in post-procedure outcome at successive follow-ups on intragroup longitudinal analysis (VAS: F=558.384 vs. F=1,529.618, Nirschl: F=791.468 vs. F=1,284.951). On intergroup analysis, VAS of group B was superior to that of group A; however, it was statistically significant (P<0.05) only from the 6-week follow-up onwards. Nirschl score of group B was significantly better throughout the period of follow-up (P<0.05). Group B returned to daily activities faster than Group A (6.2±0.44 weeks vs. 7.18±0.76 weeks). Conclusions: Concomitant pie crusting with CSI is recommended for lateral epicondylitis as it provides significantly better results than CSI alone.