Surgical Treatment of Lateral Epicondylitis
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, United States Clinical Orthopaedics and Related Research
(Impact Factor: 2.77).
11/2007; 463(463):98-106. DOI: 10.1097/BLO.0b013e3181483dc4
For the minority of people with lateral epicondylitis who do not respond to nonoperative treatment, surgical intervention is an option, but confusion exists because of the plethora of options. The surgical techniques for treating lateral epicondylitis can be grouped into three main categories: open, percutaneous, and arthroscopic. Our primary question was whether there was clear evidence suggesting one of these three approaches was superior in relieving pain, restoring strength, or reducing time to return to work. A 2002 Cochrane Collaboration Database review found no conclusions could be drawn regarding the efficacy of operative treatment given the lack of controlled trials. Although there is not enough literature to conduct a meta-analysis, we systematically reviewed the available literature to address our questions. Although there are advantages and disadvantages to each procedure, no technique appears superior by any measure. Therefore, until more randomized, controlled trials are done, it is reasonable to defer to individual surgeons regarding experience and ease of procedure.
Available from: Francesc Medina-Mirapeix
- "In the past, studies on the management of LE indicated substantial and unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments [7,8]. Currently, there is convincing evidence demonstrating that multifactorial intervention programs involving a multidisciplinary team are effective in reducing both pain and disability of patients with lateral epicondylalgia [7,9]. "
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ABSTRACT: Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments.The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE.
Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel.
Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8).
A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.
Available from: Eirik Solheim
- "The results after open surgery with recalcitrant TE have been reviewed by meta-analyses recently [20, 24]. While the different studies constituting the meta-analyses cannot be directly compared, the surgical success rates for the open technique have been reported to be between 19 and 100% with a mean of 80.4% . "
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ABSTRACT: The objectives of this study were to evaluate the results in the outpatient treatment of recalcitrant lateral epicondylitis with release of the common extensor origin according to Hohmann and to determine any prognostic factors.
Eighty tennis elbows in 77 patients with a characteristic history of activity-related pain at the lateral epicondyle interfering with the activities of daily living refractory to conservative care for at least 6 months and a confirmatory physical examination were included. Clinical outcome was evaluated using the QuickDASH score system. Data were collected before the operation and at the medians of 18 months (range 6-36 months; short term) and 4 years (range 3-6 years; medium term) postoperatively.
The mean QuickDASH was improved both at the short- and the medium-term follow-ups and did not change significantly between the follow-ups. At the final follow-up, the QuickDASH was improved in 78 out of 80 elbows and 81% was rated as excellent or good (QuickDASH<40 points). We found a weak correlation between residual symptoms (a high QuickDASH score) at the final follow-up and high level of baseline symptoms (r=0.388), acute occurrence of symptoms (r=0.362), long duration of symptoms (r=0.276), female gender (r=0.269) and young age (r=0.203), whereas occurrence in dominant arm, a work-related cause or strenuous work did not correlate significantly with the outcome.
Open lateral extensor release performed as outpatient surgery results in improved clinical outcome at both short- and medium-term follow-ups with few complications. High baseline disability, sudden occurrence of symptoms, long duration of symptoms, female gender and young age were found to be weak predictors of poor outcome.
Case series, Level IV.
Available from: Vittal Sree Rama Rao
- "Even if aetiology is attributed to various factors like bursitis, synovitis, ligament inflammation, periosteitis; the most common accepted etiology is microscopic tears with formation of reparative tissue on the lateral epicondyle. Cyriax in 1936 had explained about 26 etiological factors of tennis elbow. Still the pathology is uncertain as no published data have examined patients with acute diagnosis of tennis elbow [4,12]. "
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ABSTRACT: The aim of our study was to analyse the efficacy of operative management in recalcitrant lateral epicondylitis of elbow. Forty patients included in this study were referred by general practitioners with a diagnosis of tennis elbow to the orthopaedic department at a district general hospital over a five year period. All had two or more steroid injections at the tender spot, without permanent relief of pain. All subsequently underwent simple fasciotomy of the extensor origin. Of forty patients thirty five had improvement in pain and function, two had persistent symptoms and three did not perceive any improvement. Twenty five had excellent, ten had well, two had fair and three had poor outcomes (recurrent problem; pain at rest and night). Two patients underwent revision surgery. Majority of the patients had improvement in pain and function following operative treatment. In this study, an extensor fasciotomy was demonstrated to be an effective treatment for refractory chronic lateral epicondylitis; however, further studies are warranted.
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