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Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis.
MedLine Citation:
PMID:  23351911     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: Chronic lateral epicondylitis remains a treatment challenge. Traditional surgical treatments for lateral epicondylitis involve variations of the classic Nirschl lateral release. Anatomic studies reveal that the posterior branch or branches of the posterior cutaneous nerve of the forearm consistently innervate the lateral humeral epicondyle. We undertook the present study to determine the effectiveness of denervation of the lateral humeral epicondyle in treating chronic lateral epicondylitis.
METHODS: An institutional review board-approved prospective study included 30 elbows in 26 patients. Inclusion criteria included failure to respond to nonoperative treatment for more than 6 months and improvement in grip strength and in visual analog pain scale after diagnostic nerve block of the posterior branches of the posterior cutaneous nerve of the forearm proximal to the lateral humeral epicondyle. We excluded patients who had undergone previous surgery for lateral epicondylitis. Outcome measures included visual analog pain scale and grip strength testing. Denervation surgery involved identification and transection of the posterior cutaneous nerve of the forearm branches with implantation into the triceps. The presence of radial tunnel syndrome was noted but did not affect inclusion criteria; if it was present, we did not correct it surgically. We used no postoperative splinting and permitted immediate return to activities of daily living.
RESULTS: At a mean of 28 months of follow-up, the average visual analog scale score decreased from 7.9 to 1.9. Average grip strength with the elbow extended improved from 13 to 24 kg. A total of 80% of patients had good or excellent results, as defined by an improvement of 5 or more points on the visual analog scale for pain.
CONCLUSIONS: Denervation of the lateral epicondyle was effective in relieving pain in 80% of patients with chronic lateral epicondylitis who had a positive response to a local anesthetic block of the posterior branches of the posterior cutaneous nerve of the forearm. Radial nerve compression syndromes must be evaluated as a confounding source of symptoms and may require additional treatment in patients who fail to improve with denervation alone.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Authors:
Nicholas E Rose; Scott K Forman; A Lee Dellon
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of hand surgery     Volume:  38     ISSN:  1531-6564     ISO Abbreviation:  J Hand Surg Am     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  344-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Affiliation:
California Orthopaedic Specialists, Newport Beach, CA; and the Departments of Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, MD. Electronic address: nickrosemd@yahoo.com.
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