Email this article 
ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW)
- Authors: Salikhov M.R.1, Kuznetsov I.A.1, Zhabin G.I.1, Shulepov D.A.1, Zlobin O.V.1
-
Affiliations:
- Vreden Russian Research Institute of Traumatology and Orthopedics
- Issue: Vol 23, No 4 (2017)
- Pages: 58-69
- Section: Clinical studies
- URL: https://journal.rniito.org/jour/article/view/831
- DOI: https://doi.org/10.21823/2311-2905-2017-23-4-58-69
- ID: 831
Cite item
Full Text
Abstract
In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.
Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.
Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB) without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.
Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р<0,05). VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р<0,05). Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS) in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.
Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and increased bleeding of the wound. Patients after simple release of ECRB demonstrated minimal postoperative pain which allows early rehabilitation and return to daily and professional activities.Keywords
About the authors
M. R. Salikhov
Vreden Russian Research Institute of Traumatology and Orthopedics
Author for correspondence.
Email: virus-007-85@mail.ru
Marsel R. Salikhov — Cand. Sci. (Med.), Orthopaedics Surgeon, traumatology and Orthopedic Department N 15.
8, ul. Akad. Baykova, St. Petersburg, 195427
Russian FederationI. A. Kuznetsov
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Igor A. Kuznetsov — Dr. Sci. (Med.), Professor, Head of the Department of Sports Traumatology and Rehabilitation.
8, ul. Akad. Baykova, St. Petersburg, 195427
Russian FederationG. I. Zhabin
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Georgy I. Zhabin — Dr. Sci. (Med.), Professor, Department of Sports Traumatology and Rehabilitation.
8, ul. Akad. Baykova, St. Petersburg, 195427
Russian FederationD. A. Shulepov
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Dmitry A. Shulepov — Cand. Sci. (Med.), Laboratory Assistant, Department of Sports Traumatology and Rehabilitation.
8, ul. Akad. Baykova, St. Petersburg, 195427
Russian FederationO. V. Zlobin
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Oleg V. Zlobin — Head of the traumatology and Orthopedic Department N 15.
8, ul. Akad. Baykova, St. Petersburg, 195427 Russian FederationReferences
- Королев С.Б., Качесов А.В., Носов О.Б., Кленин А.А., Абраменков А.Н. Способ оперативного вмешательства при эпикондилите плечевой кости. Травматология и ортопедия России. 2011;(4):114-117. Korolev S.B., Kachesov A.V., Nosov O.B., Klenin A.A., Abramenkov A.N. [The method of surgical treatment of humeral epicondylitis]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics in Russia]. 2011;(4): 114-117. (in Russian).
- Cohen M.S., Romeo A.A. Open and arthroscopic management of lateral epicondylitis in the athlete. Hand Clin. 2009;25(3):331-338. doi: 10.1016/j.hcl.2009.05.003.
- Grewal R., MacDermid J.C., Shah P., King G.J. Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. J Hand Surg Am. 2009;34(5):849-857. doi: 10.1016/j.jhsa.2009.02.006.
- Кириллова Э.Р., Шнайдер Л.Л. Особенности течения эпикондилитов локтевого сустава у больных остеоартрозом. Практическая медицина. 2011;(4):114-115. Kirillova E.R., Schneider L.L. [Peculiarities of epicondylitis of elbow joint in patients with osteoarthritis]. Prakticheskaya meditsina [Practical medicine]. 2011;(4):114-115. (in Russian).
- Кириллова Э.Р., Хабиров Р.А., Шнайдер Л.Л., Ананичева Г.В. Подходы к патогенетической терапии эпикондилитов локтевого сустава. Практическая медицина. 2013;(1):109-112. Kirillova E.R., Khabirov R.A., Schneider L.L., Ananicheva G.V. [Approaches to pathogenetic therapy of epicondylitis of elbow joint]. Prakticheskaya meditsina [Practical medicine]. 2013;(1):109-112. (in Russian).
- Cyriax J.H. The pathology and treatment of tennis elbow. J Bone Joint Surg. 1936;18:921-940.
- Nirschl R.P., Pettrone F.A. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg. 1979;61(6-A):832-839.
- Boyer M.I., Hastings H.Jr. Lateral tennis elbow: “Is there any science out there?”. J Shoulder Elbow Surg. 1999;8(5):481-491.
- Baker C.L. Jr., Murphy K.P., Gottlob C.A., Curd D.T. Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results. J Shoulder Elbow Surg. 2000;9(6):475-482. doi: 10.1067/mse.2000.108533.
- Sauvage A., Nedellec G., Brulard C., Gaumet G., Mesnil P., Fontaine Ch., Wavreille G. [Arthroscopic treatment of lateral epicondylitis: a prospective study on 14 cases]. Chir Main. 2013;32(2):80-84. (in French). doi: 10.1016/j.main.2013.02.014.
- Major H.P. Lawn-tennis elbow. Br Med J. 1883;2:557.
- Morris H.P. The rider’s sprain. Lancet. 1882;120: 133-134.
- Coonrad R.W., Hooper W.R. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg. 1973;55-A(6):1177-1182.
- Werner C.O. Lateral elbow pain and posterior interosseous nerve entrapment. Acta Orthop Scand. 1979;174:1-62.
- Bisset L., Beller E., Jull G., Brooks P., Darnell R., Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. BMJ. 2006;333:939. doi: 10.1136/bmj.38961.584653.AE.
- Derebery V.J., Devenport J.N., Giang G.M., Fogarty W.T. The effects of splinting on outcomes for epicondylitis. Arch Phys Med Rehabil. 2005;86:1081-1088. doi: 10.1016/j.apmr.2004.11.029.
- Galloway M., DeMaio M., Mangine R. Rehabilitation techniques in the treatment of medial and lateral epicondylitis. Orthopedics. 1992;15(9):1089-1096.
- Burnham R., Gregg R., Healy P., Steadward R. The effectiveness of topical diclofenac for lateral epicondylitis. J Sports Med. 1998;8(2):78-81.
- Nirschl R.P., Ashman E.S. Elbow tendinopathy: Tennis elbow. Clin Sports Med. 2003;22(4):813-836.
- Buchbinder R., Green S.E., Youd J.M., Assendelft W.J., Barnsley L., Smidt N. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev. 2005;(1):CD003524. doi: 10.1002/14651858.CD003524.
- Calfee R.P., Patel A., DaSilva M.F., Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. 2008;16(1):19-29.
- Hayton M.J., Santini A.J., Hughes P.J., Frostick S.P., Trail I.A., Stanley J.K. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am. 2005;87(3):503-507. doi: 10.2106/JBJS.D.01896.
- Lo M.Y., Safran M.R. Surgical treatment of lateral epicondylitis: a systematic review. Clin Orthop. 2007;463:98-106. doi: 10.1097/BLO.0b013e3181483dc4.
- Longacre M.D., Baker III C.L., Baker C.L. Jr. Arthroscopic management of lateral epicondylitis. Oper Tech Sports Med. 2014;22(2):142-147.
- Peart R.E., Strickler S.S., Schweitzer Jr K.M. Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop. 2004;33:565-567.
- Rubenthaler F., Wiese M., Senge A., Keller L., Wittenberg R.H. Long-term follow-up of open and endoscopic Hohmann procedures for lateral epicondylitis. Arthroscopy. 2005;21(6):684-690. doi: 10.1016/j.arthro.2005.03.017.
- Almquist E.E., Necking L., Bach A.W. Epicondylar resection with anconeus muscle transfer for chronic lateral epicondyltis. J Hand Surg Am. 1998;23(4):723-731.
- Verhaar J., Walenkamp G., Kester A., van Mameren H., van der Linden T. Lateral extensor release for tennis elbow: a prospective long-term study. J Bone Joint Surg. 1993;75(7):1034-1043.
- Baumgard S.H., Schwartz D.R. Percutaneous release of the epicondylar muscles for humeral epicondylitis. Am J Sports Med. 1982;10(4):233-236.
- Stiefel E.C., Field L.D. Arthroscopic lateral epicondylitis release using the “bayonet” technique. Arthrosc Tech. 2014;3(1):135-139. doi: 10.1016/j.eats.2013.09.006.
- Smith A.M., Castle J.A., Ruch D.S. Arthroscopic resection of the common extensor origin: Anatomic considerations. J Shoulder Elbow Surg. 2003;12(4):375-379. doi: 10.1016/mse.2003.S1058274602868239.
- Baker C.L. Jr., Baker C.L. 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. 2008;36(2):254-260. doi: 10.1177/0363546507311599.
- Kaleli T., Ozturk C., Temiz A., Tirelioglu O. Surgical treatment of tennis elbow: percutaneous release of the common extensor origin. Acta Orthop Belg. 2004;70(2):131-133.
- Priest J.D., Braden V., Gerberich J.G. The elbow and tennis. Part 1. Physician Sports Med. 1980;8:80.
Supplementary files
