Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus. Studies on tennis elbow and medial epicondylalgia

J Orthop Res. 2004 Mar;22(2):321-7. doi: 10.1016/S0736-0266(03)00183-9.


There is no information on the sensory innervation at the flexor muscle origin at the medial epicondyle of the humerus and it is not known if substance P receptors (Neurokinin 1-receptors, NK1-R) are present in tendon insertions in general. In the present investigation, we have studied the muscle origin in patients suffering from medial epicondylalgia and tennis elbow. Immunohistochemistry and antibodies to substance P (SP) and CGRP as well as the general nerve marker PGP 9.5 were used. Specific immunoreactions were observed in nerve bundles and as free nerve fibers. The immunoreactive structures were partly seen in association with some of the blood vessels. The observations constitute a morphological correlate for the occurrence of nerve mediated effects in this region. By using immunohistochemistry and antibodies to NK1-R, the distribution of this receptor was studied at the insertion of the proximal tendon of the extensor carpi radialis brevis muscle at the lateral epicondyle. Specific immunoreactions were seen as varicose fibers occurring as single fibers or grouped into bundles, indicating that SP has effects in the nerves in this region. The results give further evidence for a possible neurogenic involvement in the pathophysiology of tennis elbow and in medial epicondylalgia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Calcitonin Gene-Related Peptide / metabolism
  • Female
  • Forearm / physiopathology
  • Humans
  • Humerus / pathology*
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Muscle, Skeletal / metabolism
  • Muscle, Skeletal / pathology*
  • Neuropeptides / metabolism*
  • Receptors, Neurokinin-1 / metabolism
  • Substance P / metabolism
  • Tendons / metabolism
  • Tendons / pathology*
  • Tennis Elbow / metabolism
  • Tennis Elbow / pathology*
  • Tennis Elbow / physiopathology


  • Neuropeptides
  • Receptors, Neurokinin-1
  • Substance P
  • Calcitonin Gene-Related Peptide