Microvascular supply of the lateral epicondyle and common extensor origin

Lateral epicondylitis is a common condition affecting 1% to 3% of the population. Although the exact cause is still unknown, numerous theories have been put forth. One theory suggests a hypovascular zone at the origin of the common extensor mass. This study examines the microvascular supply of the lateral epicondyle and the common extensor mass, with the use of India ink injection and the Spalteholz tissue-clearing technique. Six fresh-frozen cadaveric arms underwent serial sectioning (coronal plane in five and axial plane in one) after vascular injection with India ink. Sections were cleared via a modified Spalteholz technique. Photographs were taken before and after the clearing procedure, and the microvascular pattern of the common extensor mass and lateral epicondyle was described. Two hypovascular zones were identified in the region of the lateral epicondyle. The first was noted at the proximal lateral epicondyle just distal to the supracondylar ridge and the second 2 to 3 cm distal to the lateral epicondyle on the deep surface of the common extensor tendon. Two regions of hypovascularity were noted at the lateral epicondyle and within the common extensor origin. These hypovascular regions may preclude the normal inflammatory cascade and healing response to microtearing in this region. Thus, these zones may play a role in the etiology of lateral epicondylitis.