J Korean Soc Surg Hand.  2017 Mar;22(1):1-12. 10.12790/jkssh.2017.22.1.1.

Recent Updates on the Treatment of Lateral Epicondylitis

• Koh KH
• Lee HI

• KMID: 2375461
• DOI: http://doi.org/10.12790/jkssh.2017.22.1.1

Abstract

The natural course of lateral epicondylitis is widely regarded to be self-limiting within 1 year of symptom duration in 90% of all patients. The spectrum of treatments include simple "˜wait and see', bracing, physical therapy, corticosteroid injection, and recently some biologic injection such as autologous blood and platelet rich plasma. However, recalcitrant lateral epicondylitis which are not responding to conservative treatments can be treated with surgical treatment although much remains unclear regarding the ideal treatment. Debates surrounding open procedures are the management for the defect after resection of pathologic tissue, necessity of decortication, selective denervation procedure, etc. Since the trend is changing to minimal invasive surgery and arthroscopic release of extensor carpi radialis brevis tendon are becoming more popular these days, surgical tips and pitfall to obtain good results and avoid complications have been reported recently. Bipolar radiofrequency (RF)-based microtenotomy or percutaneous tendon release is another surgical procedures reported to be effective in lateral epicondylitis. However, there are some patients who present with persistent pain after surgical treatment. Thus, selection of ideal candidates for surgery, thorough evaluation of all pathologies prior to surgery, and adequate surgical procedures would be essential in the surgical treatment of lateral epicondylitis.

Keyword

Tennis elbow; Surgery; Review

MeSH Terms

Braces
Denervation
Humans
Pathology
Platelet-Rich Plasma
Tendons
Tennis Elbow
Tenotomy

Figure

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  Fig. 1. Magnetic resonance imaging (MRI) of coronal T2 weighted image showed accompanying lateral ulnar collateral ligament complex insufficiency in a patient with lateral epicondylitis.

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  Fig. 2. Nirschl lesion observed during the open procedure. The lesion is involving extensor carpi radialis brevis and some portion of common extensor tendon and distinguished from the relatively healthy-looking distal tendinous portion.

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  Fig. 3. Arthroscopic finding of posterior synovial plica during the surgery for lateral epicondylitis. (A) Synovial plica covering radial head prior to removal, (B) partially debrided synovial plica tissue, and (C) completion after removal of impinged synovial plica tissue between the radial head and capitellum.

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  Fig. 4. Arthroscopic view showing pathologic extensor carpi radialis brevis (ECRB) tendon and articular capsule from proximal anteromedial portal. ECRL, extensor carpi radialis longus.

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  Fig. 5. Radiofrequency based microtenotomy in a patient with chronic lateral epicondylitis.

Reference

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