Golfer and Tennis Elbow in Byzantine Turkey: Epicondylitis a Neglected Occupation/Activity Marker in Antiquity


Both lateral and medial epicondylitis are well known in modern medicine as diseases of occupation, leaving recognizable lesions on the epicondyles. We report on 36 individuals from the 8th-10th century AD Byzantine period from Kovuklukaya, near Sinop, Middle Black Sea region, Northern Anatolia, Turkey. The present study focuses on medial and lateral epicondylitis with lesions of enthesopathies and bony pits, assessing the frequency of these lesions in the skeletal series and whether these characters provide new and/or additional criteria for the diagnosis of activity patterns in archaeological specimens. We then discuss the significance of these lesions in interpreting the activities of past populations, possible reasons why these lesions were not previously reported by paleopathologists and the application of our findings to the assessment of activity patterns and occupational stress markers in past populations.

Share and Cite:

Spigelman, M. , Erdal, Y. , Donoghue, H. & Pinhasi, R. (2012). Golfer and Tennis Elbow in Byzantine Turkey: Epicondylitis a Neglected Occupation/Activity Marker in Antiquity. Advances in Anthropology, 2, 24-30. doi: 10.4236/aa.2012.21003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Al-Oumaoui, I., Jiménez-Brobeil, S., & du Souich, P. (2004). Markers of activity patterns in some populations of the Iberian Peninsula. International Journal of Osteoarchaeology, 14, 343-359.
[2] Bannister, L. H., Berry, M. M., Collins, P., Dyson, M., Dussek, J. E., & Ferguson, M. W. J. (1995). In: Gray’s Anatomy, 38th edition (pp. 512-515). Edinburgh: Churchill-Livingstone.
[3] Barber, E. J. W. (1991). Prehistoric textile: The development of cloth in the Neolithic and Bronze Ages with special reference to the Aegean. Princeton: Princeton University Press.
[4] Barton, N. J., Hooper, G., Noble, J., & Steel, W. M. (1990). Report of BOA Working Party on occupational causes of upper limb disorders. London: British Orthopaedic Association.
[5] Basoglu, B. (1972). Boyabat ve ?evresi Tarihi. Ankara: British Institute at Ankara.
[6] Benjamin, M., Kumai, T., Milz, S., Boszczyk, B. M., Boszczyk, A. A., & Ralphs J R. 2002. The skeletal attachment of tendons—Tendon “enthuses”. Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiology, 133, 931-945. doi:10.1016/S1095-6433(02)00138-1
[7] Brooks, S., & Suchey, J. M. (1990). Skeletal age determination based on the os pubis: A comparison of the Ascadi-Nemeskeri and Suchey- Brooks methods. Human Evolution, 5, 227-238. doi:10.1007/BF02437238
[8] Buikstra, J., & Uberlaker, D. H. (1994). Standards for data collection from human skeletal remains. Proceedings of a seminar at the Field Museum of Natural History, Fayetteville: Arkansas Archaeological Survey.
[9] Cardoso, F. C., & Henderson, C. Y. (2010). Enthesopathy formation in the humerus: Data from known age-at-death and known occupation skeletal collections. American Journal of Physical Anthropology, 141, 550-560.
[10] Chapman, N. E. M. (1997). Evidence for Spanish influence on activity induced musculoskeletal stress markers at Pecos Pueblo. International Journal of Osteoarcheology, 7, 497-506. doi:10.1002/(SICI)1099-1212(199709/10)7:5<497::AID-OA394>3.0.CO;2-H
[11] Claudepierre, P., & Voisin, M.-C. (2005). The entheses: Histology, pathology, and pathophysiology. Joint Bone Spine, 72, 32-37. doi:10.1016/j.jbspin.2004.02.010
[12] Crianni, R., & Fornaciari, G. (2003). Luigi Boccheriniand the Barocco Cello: An 18th Century striking case of occupational disease. International Journal of Osteoarchaeology, 13, 294-302. doi:10.1002/oa.701
[13] Crubézy, E., Goulet, J., Bruzek, J., Jelinek, J., Rouge, D., & Ludes, B. (2002). Epidemiology of osteoarthritis and enthesopathies in a European population dating back 7700 years. Joint Bone Spine, 69, 580-588. doi:10.1016/S1297-319X(02)00455-4
[14] Erdal, Y. S. (2004). Kovuklukaya (Boyabat/Sinop) ?nsanlar?n?n Sa?l?k Yap?s? ve Ya?am Bi?imleriyle ?li?kisi. Anadolu Arastirmalari, 17, 169-176.
[15] Erdal, Y. S. (2008). Occlusal grooves in anterior dentition among Ko- vuklukaya inhabitants (Sinop, Northern Anatolia, 10th century AD). International Journal of Osteoarchaology, 18, 152-166. doi:10.1002/oa.925
[16] Eshed, V., Gopher, A., Galili. E., & Hershkovitz, I. (2004). Musculoskeletal stress markers in Natufian hunter-gatherers and Neolithic farmers in the Levant: The upper limb. American Journal of Physical Anthropology, 123, 303-315. doi:10.1002/ajpa.10312
[17] Forbes, R. J. (1956). Studies ancient technology, Volume IV. Ledien: E.J. Brill.
[18] Havelokova, P., Villotte, S., Velemínsky, P., Polá?ek, L. & Dobisíková, M. (2011). Enthesopathies and activity patterns in the Early Medieval Great Moravian population: Evidence of division of labour. International Journal of Osteoarchaeology, 21, 487-504.
[19] Gore, R. M., Rogers, L. F., Bowerman, J., Suker, J., & Compere, C. L. (1980). Osseous manifestations of elbow stress associated with sports activities. American Journal of Roentgenology, 134, 971-977.
[20] Hawkey, D. E., & Merbs, C. F. (1995). Activity-induced musculoskeletal stress markers (MSM) and subsistence strategy changes among ancient Hudson Bay Eskimos. International Journal of Osteoarchaeology, 5, 324-338. doi:10.1002/oa.1390050403
[21] Kurppa, K., Viikari-Juntura, E., Kuosma, E., Huuskonen, M., & Kivi, P. (1991). Incidence of tenosynovitis or peritendinitis and epicondylitis in a meat-processing factory. Scandinavian Journal of Work, Environment and Health, 17, 32-37. doi:10.5271/sjweh.1737
[22] Larsen, C. S. (1995). Biological changes in human populations with agriculture. Annual Review of Anthropology, 24, 185-213. doi:10.1146/
[23] Lovejoy, C. O., Meindl, R. S., Pryzbeck, T. R., & Mensforth, R. P. (1985). Chronological metamorphosis of the auricular surface of the ilium: A new method for the determination of adult skeletal age at death. American Journal of Physical Anthropology, 68, 15-28. doi:10.1002/ajpa.1330680103
[24] Marklin, R. W., & Monroe, J. F. (1998). Quantitative biomechanical analysis of wrist motion in bonetrimming jobs in the meat packing industry. Ergonomics, 41, 227-237. doi:10.1080/001401398187279
[25] Masmejean, E., Dutour, O., Touam, C., & Oberlin, C. (1997). SLAC wrist bilatéral: Une entité à part: à propos d’un cas préhistorique de 7000 ans. Annales de Chirurgie de la Main et du Membre Supérieur, 16, 207-214. doi:10.1016/S0753-9053(97)80003-8
[26] Meindl, R. S., & Lovejoy, C. O. (1985). Ectocranial suture closure: A revised method for the determination of skeletal age at death based on the lateral-anterior sutures. American Journal of Physical Anthropology, 68, 57-66. doi:10.1002/ajpa.1330680106
[27] Meindl, R. S., & Lovejoy, C. O. (1989). Age changes in the pelvis: Implication for paleodemography. In M. Y. I?can (Ed.), Age markers in the human skeleton (pp. 137-168). Springfield, Illinois: Charles C Thomas.
[28] Miles, A. E. W. (1996). Humeral impingement on the acromion in a Scottish island population of c.1600 AD. International Journal of Osteoarchaeology, 6, 259-288. doi:10.1002/(SICI)1099-1212(199606)6:3<259::AID-OA270>3.0.CO;2-5
[29] Miles, A. E. W. (1999). A five-grade categorization of age-related change in the acromioclavicular joint derived from the skeletal remains of early 19th century Londoners of known sex and age. International Journal of Osteoarchaeology, 9, 83-101. doi:10.1002/(SICI)1099-1212(199903/04)9:2<83::AID-OA461>3.0.CO;2-V
[30] Miller, R. J. (1985). Lateral epicondylitis in the prehistoric indian population from Nuvakwewtaqa (Chavez Pass), Arizona). In C. F. Merbs and R. J. Miller (Eds.), Health and diseases in the prehistoric southwest (pp. 391-400). Phoenix metropolitan area, Arizona: Arizona State University.
[31] Molnar, P. (2006). Tracing prehistoric activities: Muskuloskeletal stress marker analysis of a Stone-Age population on the island of Gotland in the Baltic Sea. American Journal of Physical Anthropology, 129, 12-23. doi:10.1002/ajpa.20234
[32] Niepel, G. A., & Sit’aj, S. (1979). Enthesopathy. Clinics in Rheumatic Diseases, 5, 857-872.
[33] O’Dwyer, K. J, & Howie, C. R. (1995). Medial epicondylitis of the elbow. International Orthopaedics, 19, 69-71.
[34] Pascarelli, E. F., & Hsu, Y. P. (2001). Understanding work-related upper extremity disorders: Clinical findings in 485 computer users, musicians, and others. Journal of Occupational Rehabilitation, 11, 1- 21. doi:10.1023/A:1016647923501
[35] Peterson, J. (1997). Tracking activity patterns through skeletal remains: A case study from Jordan and Palestine. In H. G. K. Gebel, Z. Kafafi, & G. O. Rollefson (Eds.), The prehistory of Jordan II. Perspectives from 1997. Studies in Early Near Eastern production, subsistence, and environment 4 (pp. 475-492). Berlin: Ex Oriente.
[36] Priest, J. D., Jones, H. H., Tichenor, C. J. C., & Nagel, D. A. (1977). Arm and Elbow Changes in Expert Tennis Players. Minnesota Medicine, 60, 399-404.
[37] Stirland A. (1991). Diagnosis of occupationally related paleopathology. Current syntheses and future options. Washington: Smithsonian.
[38] Vukovi?, S., Krstev, S., & Maksimovi?, M. (2004). Diseases of the locomotor system in forestry workers. Srpski Arhiv za Celokupno Lekarstvo, 132, 246-249 (in Serbian).
[39] Walker-Bone, K., Palmer, K. T., Reading, I., Coggon, D., & Copper, C. (2004). Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis and Rheumatism, 51, 642-651. doi:10.1002/art.20535
[40] Werner, R. A., Franzblau, A., Gell, N., Hartigan, A., Ebersole, M., & Armstrong, T. J. (2005). Predictors of persistent elbow tendonitis among auto assembly workers. Journal of Occupational Rehabilitation, 15, 393-400. doi:10.1007/s10926-005-5945-6

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.