Elbow
Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis

https://doi.org/10.1016/j.jse.2010.02.008Get rights and content

Hypothesis

Lateral epicondylitis usually responds well to nonoperative management. A limited number of refractory cases may require surgical intervention. The objective of this study was to assess the outcome of arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in a consecutive series of patients.

Materials and methods

A retrospective review of 36 patients with lateral epicondylitis treated surgically between January 2001 and January 2004 was performed. There were 24 men and 12 women averaging 42 years at the time of surgery. In all patients, nonoperative management failed, and they underwent surgery at a mean of 19 months after the onset of symptoms. An arthroscopic release of the ECRB was performed. Data collection was performed by an independent examiner.

Results

Operative findings included 28% of patients with significant intra-articular synovitis and 36% with a Baker type 1 lesion, 39% with a type 2 lesion, and 25% with a type 3 lesion. At a mean follow-up of 3.5 years, the mean Mayo Clinic elbow score was 11.1 (range, 5 to 12). By use of visual analog scales, pain improved from 1.5 ± 1.3 preoperatively to 8.1 ± 2.4 at follow-up (P < .01). Of the patients, 10 (31%) reported mild pain with strenuous activities and 2 (6%) received no benefit from the procedure. Patients required a mean of 3.8 weeks to return to regular activities and 7 weeks to return to full work duties. No serious complications were identified.

Conclusions

Arthroscopic release of the ECRB is a viable option for recalcitrant lateral epicondylitis. This procedure appears to be safe and effective and allows for management of associated intra-articular pathology.

Section snippets

Materials and methods

Institutional Review Board clearance was obtained from Rush University Medical Center, Chicago, Illinois (study No. 04101806).

Patients enrolled in this study were operated on during a 3-year period from January 2001 to January 2004. The inclusion criteria included lateral epicondylitis for which conservative treatment measures failed, consisting of anti-inflammatory medication, physical therapy, and corticosteroid injections for a minimum of 6 months.

All patients underwent an examination and

Results

In total, 36 patients met the study criteria, 24 men and 12 women. The mean age at the time of surgery was 42 ± 7 years. The dominant arm was involved in 58% of cases. Overall, 75% of all patients described their job as requiring “repetitive motion.” Two-thirds (66%) performed work activities that were classified as “heavy manual labor” as defined by the US Department of Labor guidelines (maximum lifting ≥75 lb). Thirty-six percent of patients attributed their condition to an injury or

Discussion

Lateral epicondylitis is a common elbow diagnosis that usually responds to conservative treatment. Operative intervention may be indicated in a small percentage of recalcitrant cases. This study evaluated a surgical technique that we developed to identify and specifically release the origin of the ECRB arthroscopically.7 The goal was to provide clinical outcome data to support our previous anatomic investigations. The results show that adequate clinical outcome and pain relief can be achieved

Conclusions

We found the clinical outcomes of an arthroscopic technique that we developed to accurately release the ECRB tendon origin to be safe and effective for cases of lateral epicondylitis resistant to conservative measures. A small subset of patients do have persistent symptoms, including some who obtain minimal benefit from the procedure. This underscores the importance of preoperative education and careful patient selection.

Disclosure

Anthony A. Romeo receives royalties and research funding and is a consultant for Arthrex. However, none of these funds were applied to or conflicted with this project. Brian J. Cole receives royalties from Arthrex and Stryker. He also consults for Genzyme, Zimmer, DePuy, Arthrex, Carticept, and Regentis. Research support is provided by Arthrex, Zimmer, and DePuy. However, none of these funds were applied to or conflicted with this project.

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