Arthroscopic treatment for chronic lateral epicondylitis

Abstract

ObjectiveTo report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment.MethodsOver the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain.ResultsA total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p < 0.01). No correlations were observed using the Spearman test between the results and age, gender, length of time with symptoms before the operation or injury mechanism (p > 0.05).ConclusionArthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

Evolution of the Arthroscopic Treatment of Chronic Lateral Epicondylitis-Preliminary Result

“…Perhaps this can be prevented by avoiding the decortication of the epicondyle, in view of good results only with the debridement of injured soft tissues. When the discomfort does not improve after exhausting the conservative measures for at least 6 months, arthroscopic treatment is an option for lateral epicondylitis, good results can be obtained with an early return to work without restriction [4]. In conclusion we can say that arthroscopy is becoming a safe option every day for the treatment of recalcitrant lateral epicondylitis, with few complications.…”

“…One patient presented discomfort associated with reflex sympathetic dystrophy (Complex regional pain type 2). Bercelo et al [4] reported a patient with associated paresthesia in the lateral forearm area. None of our three patients showed signs of neurological injury.…”

“…Recently, the arthroscopic release of the tennis elbow has become popular. The debridement of the degenerated tendon, the capsular release and the underlying decortication is the most commonly used technique [1,[3][4][5][6]. The best increased knowledge of the elbow anatomy and the technical improvement and safety of the arthroscopic portals have increased the reports of the arthroscopic treatment of lateral epicondylitis.…”

Arthroscopic Management of Tennis elbow

“…16 Arthroscopic surgical treatment of recalcitrant lateral epicondylitis, 10 cases had found scores more than 90 points ranged from a minimum of 60 points to a maximum of 100 points (mean of 90), which matches the data in the literature in relation to good functional scores. In another study by Bernardo, 18 Arthroscopic management for tennis elbow. The VAS pain score decreased from a preoperative mean of 9.2 to a postoperative mean of 0.64 ,While in or study the VAS pain score improved from a preoperative mean of 8.8 to a postoperative of 0.85 and after follow up six months improved to a mean of 0.6 .…”

Upper Extremity Injuries in Tennis Players

“…Recent literature has focused on exploring outcomes of arthroscopic release and has contributed to the growing support of arthroscopy as a viable method of ECRB release for recalcitrant cases 39-42 . Studies of functional recovery after surgical ECRB release indicated that patients can typically return to play within 3-6 months after surgery 43 .…”