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Common extensor tendon

The common extensor tendon, also known as the common extensor origin, is a flat, strong tendinous structure that arises from the anterolateral surface of the lateral epicondyle of the humerus, serving as the shared proximal attachment point for several key extensor muscles in the posterior forearm.^[1]^[2] It primarily comprises the tendons of the extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), extensor digiti minimi (EDM), and extensor carpi ulnaris (ECU), with these tendons blending into a common footprint before diverging distally in the forearm to insert onto the metacarpals and phalanges.^[1]^[3] The extensor carpi radialis longus (ECRL) contributes some fibers but originates more proximally from the lateral supracondylar ridge.^[4]^[2] Anatomically, the tendon lies superficial to the lateral collateral ligament complex of the elbow, including the radial collateral and lateral ulnar collateral ligaments, and connects to the elbow joint capsule, providing structural reinforcement and stability against varus stresses.^[1]^[2] Functionally, it facilitates wrist and finger extension by transmitting forces from the extensor muscles, acting as a dynamic stabilizer for the elbow joint during gripping and repetitive motions.^[1]^[4] Variations in attachment sites are common, with the ECRB, EDC, and EDM sharing a broad origin on the superior aspect of the lateral epicondyle, while the ECU attaches more posteroinferiorly; enthesophytes (bony spurs) at these sites occur in some cases.^[3] Clinically, the common extensor tendon is most notable for its role in lateral epicondylitis (commonly called tennis elbow), a degenerative tendinosis primarily affecting the ECRB due to repetitive microtrauma from wrist extension or forceful gripping, rather than true inflammation.^[4] This condition leads to pain at the lateral elbow and can impair daily activities, with imaging such as MRI or ultrasound revealing hypoechoic, thickened tendon tissue.^[1]^[3] The tendon's superficial position makes it accessible for diagnostic evaluation and treatments ranging from conservative management to surgical debridement.^[4]

Anatomy

Origin and attachments

The common extensor tendon originates as a flattened tendinous structure from the anterolateral surface of the lateral epicondyle of the humerus, serving as a shared aponeurosis for the tendons of several superficial extensor muscles in the posterior forearm.^[5]^[6] This origin is positioned just distal to the attachment of the extensor carpi radialis longus and receives contributions from the extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris muscles, which collectively enable extension at the wrist and fingers.^[7]^[8] Proximally, the tendon's attachment extends superficially over the lateral collateral ligament complex, with its fibers blending into the elbow joint capsule and adjacent fascial layers, though it remains distinct from the posterior humeral origin of the anconeus muscle.^[5]^[8] Distally, within the proximal third of the forearm, the common extensor tendon transitions into the individual tendons of its contributing muscles; these separate and course toward the hand, where they insert onto the bases of the metacarpals (for the extensor carpi radialis brevis and ulnaris) or integrate into the extensor hoods over the metacarpophalangeal joints of the fingers (digits 2–5), facilitating attachments to the proximal, middle, and distal phalanges.^[7]^[6]

Composition and associated structures

The common extensor tendon is composed primarily of densely packed type I collagen fibers arranged in parallel bundles, which constitute 60-80% of its dry mass and provide tensile strength for force transmission.^[9] This extracellular matrix also includes approximately 2-4% elastin for elasticity and 4% proteoglycans, which facilitate hydration and flexibility, with water accounting for about 70% of the tendon's total weight.^[9]^[10] The tendon is relatively avascular throughout its midsubstance, relying on diffusion for nutrient supply, with vascularity limited to the musculotendinous junctions and peritendinous tissues.^[9] The tendon's structure is organized in distinct layers at its origin, reflecting contributions from multiple extensor muscles. The superficial layer primarily arises from the tendons of the extensor digitorum and extensor digiti minimi, forming the outermost portion.^[11] The deep layer is dominated by the extensor carpi radialis brevis tendon, with additional blending from the extensor carpi ulnaris, creating a conjoined footprint without clear histological separation between these components.^[11]^[1] Proximally, the common extensor tendon blends intimately with the lateral collateral ligament complex, including the radial collateral and lateral ulnar collateral ligaments, enhancing joint stability at the lateral epicondyle.^[1]^[12] Distally, its component tendons traverse the six dorsal compartments of the wrist, retained by the extensor retinaculum, and are enveloped by synovial sheaths within these fibrous tunnels to reduce friction during movement.^[13]^[14] Vascular supply to the common extensor tendon derives mainly from branches of the radial recurrent artery, which anastomose with the posterior interosseous artery to perfuse the peritendinous regions and muscle origins.^[15] Innervation is provided by the posterior interosseous nerve, a branch of the radial nerve, which supplies sensory fibers to the tendon for nociception and proprioception, though motor innervation targets the associated extensor muscles.^[16]^[9]

Function

Role in wrist and finger extension

The common extensor tendon, originating from the lateral epicondyle of the humerus, serves as the shared proximal attachment point for several superficial extensor muscles of the forearm, enabling key movements of the wrist and hand. Specifically, it gives rise to the extensor carpi radialis brevis (ECRB) and extensor carpi ulnaris (ECU), whose tendons facilitate wrist dorsiflexion (extension) in a coordinated manner, with the ECRB acting as the primary dorsiflexor to produce the majority of extension torque at the wrist joint.^[7]^[15] Additionally, the common extensor tendon is the origin for the extensor digitorum (ED) and extensor digiti minimi (EDM) tendons, which extend the metacarpophalangeal joints of the fingers (digits 2–5 for ED and digit 5 for EDM). These tendons transmit contractile forces from the forearm musculature distally to the extensor expansions (also known as dorsal hoods) over the digits, allowing for synchronized extension of the fingers while maintaining balance with flexor activity.^[7]^[17] During functional activities such as gripping, the common extensor tendon supports wrist extension to optimize hand positioning, preventing excessive flexion that would reduce grip efficiency by limiting flexor tendon excursion. Biomechanically, the associated extensor tendons endure notable tensile loads during repetitive extension; for instance, in vitro simulations of dynamic wrist flexion-extension cycles have recorded peak forces of 43.9–50.9 N across the ECRB, ECRL, and ECU, underscoring the tendon's capacity to handle cumulative stress without failure under normal conditions.^[18]^[19]

Contribution to elbow stability

The common extensor tendon serves as a dynamic stabilizer of the elbow joint during flexion and extension cycles, primarily by generating tension across the lateral epicondyle to resist varus forces that could otherwise lead to lateral deviation.^[12] This muscular contribution enhances overall joint integrity through compressive forces exerted by the crossing extensor muscles, acting as a secondary constraint alongside the capsule and radiohumeral articulation.^[20] In addition to its varus-resisting role, the tendon provides secondary restraint against valgus stress.^[21] The lateral elbow musculature, including the common extensor origin, generates a dynamic stabilizing moment that counters excessive medial opening under load.^[21] The common extensor tendon integrates closely with the lateral ulnar collateral ligament, blending at its origin to collectively maintain posterolateral rotatory stability and prevent radial head subluxation during combined varus and external rotation stresses.^[12] This synergy ensures balanced force distribution, where the tendon shares a substantial portion of the varus restraint load with the radial collateral ligament under physiological conditions.^[12]

Clinical significance

Common pathologies

The most prevalent pathology affecting the common extensor tendon is lateral epicondylitis, commonly known as tennis elbow, characterized by microtears and angiofibroblastic degeneration at the origin of the extensor carpi radialis brevis (ECRB) tendon due to repetitive microtrauma.^[22]^[23] This degenerative tendinosis typically presents with pain at the lateral elbow exacerbated by gripping or wrist extension, often without acute inflammation.^[24] It affects 1-3% of the general population annually, with peak incidence between ages 40 and 60.^[24] Tendon tears of the common extensor origin range from partial disruptions, which are frequently linked to underlying overuse and degenerative changes like those in epicondylitis, to complete ruptures resulting from acute trauma.^[25]^[26] Partial tears commonly manifest as localized pain and reduced tensile strength in the tendon fibers, accompanied by hematoma formation, while complete avulsions are rarer and lead to marked weakness in wrist and finger extension as well as grip strength.^[25]^[27] Other conditions include enthesopathy at the lateral epicondyle insertion, involving inflammatory or degenerative changes at the tendon-bone interface beyond typical epicondylitis.^[28] Risk factors for these pathologies center on repetitive wrist extension and biomechanical overload, particularly from eccentric contractions, common in sports such as tennis and occupations involving prolonged gripping or tool use like painting.^[29]^[24]

Diagnosis and treatment

Diagnosis of common extensor tendon disorders, such as lateral epicondylitis, primarily relies on clinical examination. Patients typically present with pain at the lateral epicondyle that worsens with resisted wrist or finger extension. The Cozen's test, involving resisted wrist extension with the elbow extended and forearm pronated, reproduces pain at the lateral epicondyle and supports the diagnosis.^[24] Additional provocative maneuvers, such as resisted middle finger extension, further confirm tendon involvement by eliciting localized tenderness.^[23] Imaging is not routinely required for initial diagnosis but may be used to rule out differentials or assess severity; ultrasound reveals hypoechoic regions indicating tendinopathy, while MRI visualizes partial tears or associated soft tissue damage.^[24] Electromyography (EMG) is employed if nerve entrapment, such as radial tunnel syndrome, is suspected to differentiate from pure tendon pathology.^[23] Conservative management forms the cornerstone of treatment for most cases, emphasizing rest, activity modification, and symptom relief. Initial interventions include rest to avoid aggravating activities, application of ice for 15 minutes several times daily, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to reduce pain and inflammation.^[30] Physical therapy plays a key role, incorporating eccentric strengthening exercises for the extensor muscles, which promote tendon remodeling and yield improvement in up to 90% of mild cases.^[24] Counterforce bracing or wrist splints offloads the tendon by redistributing stress during wrist extension, enhancing comfort during daily activities.^[23] Corticosteroid injections provide short-term relief by decreasing local inflammation, though they are used judiciously due to potential tendon weakening; platelet-rich plasma (PRP) injections offer an alternative for chronic cases, with recent evidence (as of 2025) indicating superior long-term pain relief and functional outcomes compared to corticosteroids.^[30]^[31] Extracorporeal shock wave therapy (ESWT) is another non-invasive option that has demonstrated efficacy in reducing pain and improving function in randomized trials.^[32] For refractory cases persisting beyond 6-12 months despite conservative measures, surgical intervention is considered. Open or arthroscopic debridement removes degenerated tendon tissue from the extensor carpi radialis brevis (ECRB), the most commonly affected portion, followed by decortication of the epicondyle to promote revascularization.^[24] In instances of partial or full tendon tears, repair using suture anchors reattaches the tendon to bone, restoring integrity.^[23] Postoperative rehabilitation involves immobilization for 1-2 weeks, followed by gradual progressive loading exercises to regain strength and range of motion. Outcomes for nonoperative treatment are favorable, with 80-95% of patients achieving resolution of symptoms within 6-12 months through consistent adherence to therapy.^[23] Surgical success rates range from 80-90%, with most patients returning to pre-injury activities after 4-6 months of rehabilitation, though recurrence can occur if underlying biomechanical issues persist.^[24]

References

[1]
Common extensor origin of the elbow | Radiology Reference Article
Jan 17, 2025 · The common extensor origin is a flat tendinous structure originating from the anterolateral surface of the lateral epicondyle.
[2]
Common extensor tendon - e-Anatomy - IMAIOS
The common extensor tendon is a strong, shared tendinous structure that originates from the lateral epicondyle of the humerus. It acts as a crucial point of ...
[3]
Detailed MRI–Anatomic Study of the Lateral Epicondyle of the Elbow ...
Classically in the literature, a common extensor tendon is described as attaching to the lateral epicondyle and consisting of the tendons of the ECRB, EDC, ...
[4]
Common Extensor Tendon - an overview | ScienceDirect Topics
The common extensor tendon refers to the tendon that originates from the lateral epicondyle of the elbow and is involved in lateral epicondylitis.
[5]
Common extensor origin of the elbow | Radiology Reference Article
Jan 17, 2025 · The common extensor origin is a flat tendinous structure originating from the anterolateral surface of the lateral epicondyle.
[6]
https://pubs.rsna.org/doi/full/10.1148/radiol.2015141950
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Anatomy, Shoulder and Upper Limb, Wrist Extensor Muscles - StatPearls - NCBI Bookshelf
### Summary of Common Extensor Tendon and Extensor Muscle Origins and Attachments
[8]
Common extensor tendon - e-Anatomy - IMAIOS
The common extensor tendon is a strong, shared tendinous structure that originates from the lateral epicondyle of the humerus. It acts as a crucial point of ...
[9]
Common extensor tendon - Wikipedia
The common extensor tendon is a tendon that attaches to the lateral epicondyle of the humerus. A 3D medical animation still shot illustrating inflammation of ...
[10]
Anatomy, Tendons - StatPearls - NCBI Bookshelf - NIH
May 1, 2024 · [13] Collagen makes up approximately 65% to 80% of the extracellular matrix. The predominant collagen type in tendons is type I. Type III ...
[11]
Structure of the tendon connective tissue - PubMed
Tendons consist of collagen (mostly type I collagen) and elastin embedded in a proteoglycan-water matrix with collagen accounting for 65-80%.
[12]
Extensor carpi radialis brevis. An anatomical analysis of its origin
Aug 7, 2025 · ... The extensor carpi radialis brevis tendon represents its deepest layer whereas the extensor digitorum communis tendon constitutes the most ...
[13]
The elbow: review of anatomy and common collateral ligament ... - NIH
Apr 3, 2019 · The RCL is a fan-shaped ligament that originates at the lateral ... The common extensor tendon origin is the secondary soft-tissue ...
[14]
Extensor Tendon Compartments - Hand - Orthobullets
Mar 20, 2022 · Extensor Tendon Compartments ; 1. EPB APL. De Quervain's tenosynovitis ; 2. ECRL ECRB. Intersection syndrome ; 3. EPL. Drummer's wrist, traumatic ...
[15]
Extensor tendon mechanism - AO Surgery Reference
The extensor tendon mechanism works by pulling the extensor tendons (black arrows) towards the forearm, which causes the fingers to extend at the MCP joint.
[16]
Anatomy, Shoulder and Upper Limb, Forearm Extensor Carpi ... - NCBI
The extensor carpi radialis brevis originates from the lateral epicondyle of the humerus by a common tendon shared with other muscles of the posterior ...
[17]
Posterior Interosseous Nerve - Anatomy - Orthobullets
May 21, 2025 · common extensors. ECRB (often from radial nerve proper, but can be from PIN); Extensor digitorum communis (EDC); Extensor digiti minimi (EDM) ...
[18]
Management of Extensor Tendon Injuries - PMC - PubMed Central
Feb 23, 2012 · Extension of the first digit is controlled by two muscles, extensor pollicis longus and brevis. The path of these two tendons defines the “ ...
[19]
Extensor carpi radialis longus muscle - Kenhub
Extensor carpi radialis longus is superficial to the deep group of forearm extensors and the belly of the anconeus. The muscle is also lateral to brachialis and ...Missing: ECRB | Show results with:ECRB<|separator|>
[20]
Wrist tendon forces during different dynamic wrist motions - PMC - NIH
The purpose of this study was to examine the in vitro tendon forces in six wrist flexor and extensors to determine if their force contribution changes during ...
[21]
Stability of the Elbow Joint: Relevant Anatomy and Clinical ...
The secondary constraints are the radiohumeral articulation, the common flexor-pronator tendon, the common extensor tendon and the capsule. Fig. (2). Fig. (2).
[22]
Ultrasound evaluation shows increase in laxity after partial common ...
Aug 28, 2021 · The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability ... elbow: is the common extensor tendon an ...
[23]
Lateral Epicondylitis (Tennis Elbow) - Medscape Reference
Jul 19, 2024 · Most typically, the primary pathology is tendinosis of the extensor carpi radialis brevis (ECRB) tendon 1-2 cm distal to its attachment on the ...
[24]
Tennis Elbow (Lateral Epicondylitis) - OrthoInfo - AAOS
The tendon usually involved in tennis elbow is called the extensor carpi radialis brevis (ECRB), which attaches the ECRB forearm muscle to the lateral ...
[25]
Lateral Epicondylitis (Tennis Elbow) - StatPearls - NCBI Bookshelf
... common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB) tendon. Tennis elbow primarily results from the repetitive strain caused ...History And Physical · Treatment / Management · Complications
[26]
Acute partial rupture of the common extensor tendon - PMC - NIH
Rupture of the common extensor tendon is usually partial and acute at diagnosis, and it is characterized by rupture of the fibers with interposed hematoma.
[27]
Common extensor tendon injury | Radiology Reference Article
Dec 27, 2022 · Common extensor tendon injury. Last revised ... lateral collateral complex ligament injuries, especially lateral ulnar collateral ligament ...
[28]
Complete Rupture of Common Extensor Origin of Elbow
Complete avulsion of the common extensor origin of the elbow is a very rare injury which significantly weakens upper limb function.Missing: FMA ID 32675
[29]
Enthesopathies - StatPearls - NCBI Bookshelf - NIH
Enthesopathies encompass a broad range of pathologies that include ligamentous and tendinous injuries. They are relatively common and can be the initial ...
[30]
Elbow joint involvement in rheumatoid arthritis patients: Clinical and ...
Effusion/synovial hypertrophy was the most common abnormality (31.9 %), followed by structural abnormalities at the common extensor tendon (26.6 %). There ...
[31]
Rheumatoid Arthritis Symptoms
Extensor tendon rupture at the dorsum of the hand is a common and disabling problem. Deformity of the hand from Rheumatoid Arthritis. Reprinted from the ...
[32]
Lateral Epicondylitis (Tennis Elbow) - Shoulder & Elbow - Orthobullets
May 5, 2025 · Lateral Epicondylitis (also known as Tennis Elbow) is an overuse injury caused by eccentric overload at the origin of the common extensor tendon ...<|separator|>
[33]
Tennis elbow - Diagnosis and treatment - Mayo Clinic
Apr 29, 2025 · Shots. Different types of shots into the affected tendon are used to treat tennis elbow. They include corticosteroids and platelet-rich plasma.Symptoms and causes · Doctors and departments · Care at Mayo Clinic<|control11|><|separator|>