Clin Orthop Surg.  2009 Sep;1(3):123-127. 10.4055/cios.2009.1.3.123.

Mini-open Muscle Resection Procedure under Local Anesthesia for Lateral and Medial Epicondylitis

• Cho BK
• Kim YM
• Kim DS
• Choi ES
• Shon HC
• Park KJ
• Lee EM

• KMID: 999389
• DOI: http://doi.org/10.4055/cios.2009.1.3.123

Abstract

BACKGROUND
This study examined the clinical results of surgical treatment using a mini-open muscle resection procedure under local anesthesia for intractable lateral or medial epicondylitis. METHODS: Forty two elbows (41 patients) were treated surgically for lateral or medial epicondylitis. The indication for surgery was refractory pain after six months of conservative treatment, or a history of more than three local injections of steroid, or severe functional impairment in the occupational activities. The treatment results were assessed in terms of the pain using the visual analogue scale (VAS), Roles & Maudsley score, and Nirschl & Pettrone grade. RESULTS: The preoperative VAS scores of pain were an average of 5.36 at rest, 6.44 at daily activities, and 8.2 at sports or occupational activities. After surgery, the VAS scores improved significantly (p < 0.01): 0.3 at rest, 1.46 at daily activities, and 2.21 at sports or occupational activities. The preoperative Roles & Maudsley score was acceptable in 6 cases, and poor in 36 cases, which was changed to excellent in 23 cases, good in 16 cases, acceptable in 3 cases after surgery. According to the grading system by Nirschl & Pettrone, 23 cases were excellent, 18 cases were good, and the remaining 1 case was fair. Overall, 41 cases (97.6%) achieved satisfactory results. Postoperative complications were encountered in three cases. Subcutaneous seroma due to the leakage of joint fluid in two patients was managed by additional surgery and suction drainage, and resulted in a satisfactory outcome. One patient complained of continuous pain on occupational activity, but her pain at rest was improved greatly. CONCLUSIONS: The mini-open muscle resection procedure under local anesthesia appears to be one of effective methods for intractable lateral or medial epicondylitis.

Keyword

Lateral epicondylitis; Medial epicondylitis; Local anesthesia; Mini-open; Muscle resection

MeSH Terms

Adult
*Anesthesia, Local
Female
Humans
Male
Middle Aged
Muscle, Skeletal/*surgery
Pain/etiology
Pain Measurement
Tennis Elbow/complications/*surgery
Treatment Outcome

Figure

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  Fig. 1 Via minimal skin incision, origin of extensor carpi radialis brevis (ECRB) muscle was approached. The origin of ECRB muscle was degenerated with partial tearing, scarring and friable granulation.

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  Fig. 2 After detaching the origin of extensor carpi radialis brevis muscle, multiple holes were made by microfracture technique to ensure bleeding from the bony bed.

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