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Background <p>Refractory lateral epicondylitis (LE) cannot be fully explained by tendon degeneration alone. Posterior interosseous nerve (PIN) compression has been suggested as an overlooked cause of persistent pain. This study investigated the prevalence and clinical significance of PIN involvement in refractory LE, focusing on neuropathic features and their electrodiagnostic correlations.</p> Methods <p>We conducted a cross-sectional study of 62 patients (18–65 years) with refractory LE, defined as symptoms lasting &gt; 6 months despite standard conservative and interventional treatment. Clinical assessments comprised the Visual Analogue Scale (VAS), Douleur Neuropathique-4 (DN4), and Patient-Rated Tennis Elbow Evaluation (PRTEE). Provocative tests, motor deficits, nocturnal pain, paresthesia, and Frohse tenderness were systematically recorded. EMG was performed by a blinded neurophysiologist using standard diagnostic criteria for PIN.</p> Results <p>PIN was detected in 19 of 62 patients (30.6%). Demographics were comparable, but repetitive high-force work and smoking were significantly more common in the PIN group (<i>p</i> &lt; 0.05). These patients reported higher pain (median VAS 9.0 vs. 7.0) and DN4 scores (4.0 vs. 2.0; both <i>p</i> &lt; 0.001). Nocturnal pain, distal/proximal forearm pain, Frohse tenderness, and paresthesia were strongly associated with PIN (all <i>p</i> &lt; 0.001). PRTEE scores showed greater disability (<i>p</i> &lt; 0.001).</p> Conclusion <p>PIN compression is a frequent and clinically significant comorbidity in refractory LE, affecting nearly one-third of patients. Recognizing this condition is essential because persistent symptoms may be driven by neuropathic pain mechanisms rather than tendon degeneration alone. Incorporating targeted clinical screening and selective EMG evaluation may enhance diagnostic accuracy, prevent unnecessary interventions, and support more individualized treatment strategies.</p>

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Dual pathology in lateral elbow pain: the overlooked role of posterior interosseous nerve compression in refractory lateral epicondylitis

  • 期刊论文

  • 发表日期：

    2025年11月26日

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  • Ömer Faruk Bucak,
  • Umit Yalcin,
  • Cigdem Cinar,
  • Evrim Coskun

摘要

Background

Refractory lateral epicondylitis (LE) cannot be fully explained by tendon degeneration alone. Posterior interosseous nerve (PIN) compression has been suggested as an overlooked cause of persistent pain. This study investigated the prevalence and clinical significance of PIN involvement in refractory LE, focusing on neuropathic features and their electrodiagnostic correlations.

Methods

We conducted a cross-sectional study of 62 patients (18–65 years) with refractory LE, defined as symptoms lasting > 6 months despite standard conservative and interventional treatment. Clinical assessments comprised the Visual Analogue Scale (VAS), Douleur Neuropathique-4 (DN4), and Patient-Rated Tennis Elbow Evaluation (PRTEE). Provocative tests, motor deficits, nocturnal pain, paresthesia, and Frohse tenderness were systematically recorded. EMG was performed by a blinded neurophysiologist using standard diagnostic criteria for PIN.

Results

PIN was detected in 19 of 62 patients (30.6%). Demographics were comparable, but repetitive high-force work and smoking were significantly more common in the PIN group (p < 0.05). These patients reported higher pain (median VAS 9.0 vs. 7.0) and DN4 scores (4.0 vs. 2.0; both p < 0.001). Nocturnal pain, distal/proximal forearm pain, Frohse tenderness, and paresthesia were strongly associated with PIN (all p < 0.001). PRTEE scores showed greater disability (p < 0.001).

Conclusion

PIN compression is a frequent and clinically significant comorbidity in refractory LE, affecting nearly one-third of patients. Recognizing this condition is essential because persistent symptoms may be driven by neuropathic pain mechanisms rather than tendon degeneration alone. Incorporating targeted clinical screening and selective EMG evaluation may enhance diagnostic accuracy, prevent unnecessary interventions, and support more individualized treatment strategies.