Lateral epicondylitis: a comparative study of open and arthroscopic lateral release.

Lancaster Orthopedic Group, Lancaster, Pennsylvania, USA.
American journal of orthopedics (Belle Mead, N.J.) 12/2004; 33(11):565-7.
Source: PubMed

ABSTRACT In this article, we retrospectively review cases of resistant lateral epicondylitis (tennis elbow) and compare treatment with open release versus arthroscopic release. From 1997 to 2002, 87 patients were treated: 54 with open procedures and 33 with arthroscopic procedures. Seventy-five patients were available for follow-up. Mean duration of preoperative symptoms was 16 months for open cases and 22 months for arthroscopic cases. All patients had a minimum of 6 months of conservative treatment before surgery. Results showed no significant difference in outcomes. For example, 69% of open cases and 72% of arthroscopic cases had good or excellent outcomes. Notably, patients treated with arthroscopic release returned to work earlier than patients treated with open release did, and they required less postoperative therapy.

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    ABSTRACT: The etiology, treatment, and patient management in cases of chronic epicondylitis, within the legislation on occupational disease, remain highly controversial. Recognition as an occupational disease has a negative influence on the functional result of epicondylitis treated with aponeurotomy and neurolysis of the motor branch of the radial nerve. Twenty-eight patients (30 cases of epicondylitis) were operated between January 2007 and January 2008. There were nine men and 19 women whose mean age was 46.1years. A preoperative EMG found anomalies in the deep posterior interosseous nerve in all cases. Patients were divided into two groups: one group of patients recognized as having an occupational disease and a group of patients whose disease was not considered occupation-related. The patients were seen at follow-up at a mean 21.8months. In the group of patients with occupational disease, there were six excellent, nine good, and five acceptable results; in the second group, there were six excellent, two good, and two acceptable results. Recognition of epicondylitis as an occupational disease has a significant influence only on the time to pain relief and the result on strength. Level IV. Retrospective study.
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    ABSTRACT: Lateral epicondylitis is the most common cause of lateral sided elbow pain in adults. While conservative treatment can relieve the symptoms, recalcitrant pain often requires surgical intervention. Various methods have been described including open, mini-open, percutaneous, and partial lateral epicondylectomy. Arthroscopic treatment for lateral epicondylitis may replace all other techniques. This article provides a systematic approach to the treatment of lateral epicondylitis. Key Words: Lateral epicondylitis—Arthroscopic—Lateral epicondylosis—Elbow arthroscopy. Lateral epicondylitis is the most common cause of lateral elbow pain in adults (Fig. 1). 2 This chronic over-use injury is the result of multiple microtraumatic events that cause disruption of the origin of the extensor carpi radialis brevis tendon (ECRB) (Fig. 2). 9 Histologic stud-ies show no evidence of an inflammatory response, but rather a disorganized pattern of fibroblasts and neovas-cularization (angiofibroblastic hyperplasia) (Fig. 3) 9 Commonly known as "tennis elbow," this condition has been linked to playing tennis and golf. Today, lateral epicondylitis is seen more often in the workplace with activities that require repetitive motion of the forearm, wrist, and hand. Affected individuals have difficulty performing activities of daily living and sports and work activities that require wrist extension and supination. Evidence shows that 90% of patients heal with con-servative treatment. 6 Early in the treatment, the physician should rule out the presence of necrotic tissue in the ECRB or gross elbow instability (posterolateral rotatory instability) because these patients would not respond to nonsurgical management. Conservative treatment in-volves activity modifications, nonsteroidal medications, braces, single steroid injection (beware of depigmenta-tion of the skin), and occupational hand therapy (Fig. 4). Studies have shown that extracorporeal shock-wave ther-apy has not been proven to play a role in the treatment of this condition although a by product can be the onset of migraine headaches. 11,21,24 In refractory cases with failed conservative treatment, surgical intervention is indicated. Open, 2,4,9 percutaneous, 3,7,19 and arthroscopic tech-niques 1,5,10,12,13,15,16,20 all have been described to treat lateral epicondylitis with good results (Fig. 5). Each technique has possible complications that are well doc-umented in the literature. Although the open technique remains the "gold standard," arthroscopic surgery done by trained specialists can address concomitant, and often missed, intra-articular pathology (a frequent cause of residual pain and "recurrence"). 1,14,15 Studies also show that arthroscopic treatment offers a quicker rehabilitation and early return to work. 1,15 This article describes arthro-scopic lateral epicondylectomy, the authors' preferred technique to treat patients with lateral epicondylitis now in 2006.
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