Arthroscopic Debridement of the Extensor Carpi Radialis Brevis for Recalcitrant Lateral Epicondylitis

Author(s): Lattermann C, Romeo AA, Anbari A, Meininger AK, McCarty LP, Cole BJ, Cohen MS

Source: J Shoulder Elbow Surg 19(5): 651-56. 2010.

Summary:

This is a retrospective review of 36 patients with lateral epicondylisits treated surgically over a 3 year period of time.  All patients had failed a nonoperative management.  Patients underwent surgery at a mean of 19 months after the onset of symptoms using an arthroscopic release of the Extensor Carpi Radialis Brevis.  The mean follow-up was 3.5 years, the mean Mayo Clinic elbow score was 11.1 at follow-up.  Using visual analog scales, Pain improved from 1.5 to 8.1 at follow-up.  One-third of patients reported mild pain with strenuous activities and 6% of patients received no benefit from the procedure.  Mean return to full activity was 3.8 weeks with 7 weeks to return to full office duties.

The significance of this study is that it indicates a really consistent outcome from the surgical treatment of lateral epicondylitis.  It is of note that the original description by Baker et al showed 95% better or much better post-operatively.  However, only 62% of patients were relatively pain free and 10% had pain with everyday activities, similar to the results with open release. Both of these articles indicate that the arthroscopic procedure allows visualization of intra articular pathology but has very similar outcomes to open release.  However, in all series, there remains a subset of surgically treated patients with symptoms.  This is important information to share with patients preoperatively.