A Novel Technique for the Surgical Management of Chronic Lateral Epicondylitis

Abstract

Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in most cases. However, when conservative treatment fails, surgery is required for resistant cases. In this study, we describe a novel technique for the management of chronic lateral epicondylitis. The advantage of our technique is that all the 3 major components of the disease (as also all types of failure described by Morrey) are simultaneously dealt with, that is, pathology of the tendon, posterior interosseous nerve compression and intra-articular pathology are all addressed. We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated with our technique at our Institute from 2008 to 2013 with a minimum 2 years follow up. We included patients between 18 and 65 years of age who in addition to lateral epicondylitis also had an intra-articular pathology along with symptoms/signs suggestive of posterior interosseous nerve compression and had undergone a conservative trial of atleast 12 months. Excluded were those cases with localized infection and severe ankylosis, whereas previous surgery on the same elbow was a relative contraindication. Postoperatively all patients showed improvement in the VAS score and grip strength. Twelve of the 14 patients (85.7%) in our series had good to excellent functional outcomes on the Mayo Elbow Performance Index. This technique can therefore be recommended for wider surgical use; however, prospective randomized studies with a longer follow-up would add further evidence about the effectiveness of our technique.

Chronic Pain Associated with Lateral Epicondylitis: Treatment with Radiofrequency

“…Open surgical resection of the extensor carpi radialis brevis tendon was traditionally the gold standard [43,44], but recently it is being reevaluated [45]. Some surgeons recommend more extensive procedures with simultaneous posterior interosseous nerve decompression and intra-articular pathology resolution [46], and others prefer collateral ligament repair [47]. To reduce the surgical aggressiveness, several arthroscopic extensor tendon release techniques have been introduced [48][49][50] finding that they render equivalent clinical results to the open surgical resection of the same anatomical structures [51,52].…”