Title: Surgical Management of Tennis Elbow- A Comparative Study

Authors: Dr Manoj Kumar R, Dr Sabarisree M

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i5.171

Abstract

Introduction: Tennis elbow denotes a symptom complex characterized by pain in the lateral epicondylar area of the elbow which is accentuated by active contraction or passive stretching of muscles originating from the involved epicondyle - also known as lateral epicondylitis.

Materials and Methods: A prospective study of 80 cases of tennis elbow not responding to conservative treatment was done at the Department of Orthopaedics, Govt Medical College, Thiruvananthapuram.

Results: At one year excellent results were found in 35% of closed tenotomy, 45% of open tenotomy, 50% of Nirschl's release and 55% of Boyd and McLeod release. Good results were obtained in 45% of closed tenotomy, 40% of open tenotomy, 35% of Nirschl's release and 40% of Boyd and McLeod release. Fair results were obtained in 10% each of closed tenotomy, open tenotomy and Nirschl's release, 5% of Boyd and McLeod release. Poor results were obtained in 10% of closed tenotomy, 5% each of open tenotomy and Nirschl's release. There was no poor result in Boyd and McLeod release.

Conclusion: Surgery is indicated in tennis elbow resistant to conservative treatment. Percutaneous release and open extensor release produce nearly as good result as Nirschl's release and Boyd and McLeod release. Open release produced slightly better results than percutaneous release as the aponeurosis is seen and released. Most of the patients benefited from surgery.

Keywords: Tennis elbow, Nirschls release, Boyds and McLeods release.

References

1.      Baumgard S.H., Schwartz P.R : Percutaneous release of epicondylar masses for humeral epicondylitis, Am. J. Sports Med 1982, July- • August 10(4), 233-6.

2.      Bosworth D.M : Role of orbicular ligament in tennis elbow - Journal of Bone and Joint Surgery (JBJS) 37 - A 527, 1955.

3.      Bosworth D.M. : Surgical treatment of tennis elbow, JBJS 47 - A, 1533, 1965.

4.      Boyd H.B, McLeodA.C : Tennis elbow JBJS 47 A 1183, 1973.

5.      Briggs C.A, Elliott B.C : Lateral epicondylitis - A review of structures associated with tennis elbow. AnatClin 1985; 7(3) : 149-53.

6.      Burton A.K. Grip strength and forearm straps in tennis elbow Br. J. Sports Medicine 1985 March, 19(1) : 37-8.

7.      Cabot A. Tennis elbow a curable affliction Orthop Rev 1987, May, 16 (5) : 322-6.

8.      Calvert P.T, Allum R.L, Mac Pherson B, BentlyG : Simple lateral release in treatment of tennis elbow JR Soc Med 1985, Nov, 78(11), 912-5.

9.      Campbell's Operative Orthopaedics, Eight edition Volume 3.

10.  Chard M.D., CawstonT.C : Rotator cuff degeneration and lateral epicondylitis - a comparative histological study, Am Rheum Dis 1994 Jan : 53(1), 30-4.

11.  Chop W.M : Tennis elbow, Post grad Med 1989 Oct; 86(5) 301-4, 307-8.

12.  J. CoenenC : A diagnostic sign in epicondylitishumeriradialis, Z «Orthop 1986 May - June; 124(3) : 323-6.

13.  Coonrad R.W. and Hooper W.R : Tennis Elbow Course, Natural history, Conservative and Surgical treatment JBJS 55-A 1177, 1973.

14.  CyriaxJ.H : Pathology and treatment of tennis elbow, JBJS 18: 921,1936.

15.  CyriaxJ.H : Text book of Orthopaedic Medicine, 6th Edition Volumeone.

16.  Das. S, Manual of Clinical Surgery Third edition.

17.  Garden R.S : Tennis Elbow JBJS 43 B 100, 1961.

18.  oldberg E.J, Abraham E, Siegel I : The surgical treatment of chroniclateral humeral epicondylitis by common extensor release, ClinOrthop 1988 Aug, 233, 258-12.

19.  Heyse - Moore G.H : Resistant tennis elbow J. Hand Surgery (Rr) 1989 Feb : 9(1) : 64-6.

20.  Kanien M - A rational management of tennis elbow, Sport Med 1990 Mar, 9(3) : 173-91.

21.  Kaplan E.B : Treatment of tennis elbow by denervation JBJS 41 -A : 147; 1959.

22.  Kaplan P.E : Posterior interosseus neuropathy : Natural history, Arch Phy and Rehabil 1984 July; 65(7), 399-400.

23.  Leach R.E , Miller J.K, Lateral and Medial epicondylitis of tennis elbow, Clin Sport Med 1987 Apr 6(2), 259-72.

24.  Le Heac J.C, Le Rebeller.A :Epicondylitis after treatment with fluoroquinoline antibotics JBJS 77-B Mar 1995, 293.

25.  Makai F and Pink M, Diagnosis and treatment of enthesopathy of the radial humeal condyle, ActaUnivPalacki; OlacueFac Med, 1989, 122, 349-54.

26.  Mercer's Orthopaedic Surgery Eighth edition.

27.  Mills C.P : The treatment of tennis elbow Br Med J 1928.

28.  Molsberger A, Hille E - The analgesic effect of acupuncture in chronictennis elbow pain Br J Rheuaob 1994 Dec, 33(12): 116 2-5.

29.  Newey M.L, Patterson M.H : Pain relief follow tennis elbow release JR CollSuyEdn 1994 Feb, 39(1), 60-1.

30.  Nirschl R.P, Pettrone F.A : Surgical treatment of lateral epicondylitis JBJS 61 A 832, 1979.

31.  Nirschl R.P : Lateral extensor release for tennis elbow JBJS As 1994 Jun; 76(6) : 951.

32.  Price R, Sinclair H, Heinvich I, Gibson T : Local injection treatment of tennis elbow - hydrocortisone, triamcinolone and lignocaine compared. Br J Rheumatol 1991 Feb; 30(1) : 39-49.

33.  Regan W, Wold LE, Conred R, MooreyB.F: Microscopic histopathology of chronic refractory lateral epicondylitis Au J Sports Med 1992 Nov-Dec 20(6) : 746-9.

34.  Roles N.C and Moudsley R.H : Radial tunnel syndrome JBJS 54-B 499, 1972.

35.  Saillaat C, Edward B, Benezed J.P, Roy Camille, Never J : Surgical treatment of refractory tennis elbow, Ana Chir 1989; 43(6) : 486-90.

36.  Spencer C.E, Herndon C.H : Surgical treatment of tennis elbow - Course, Natural history, Conservtive and Surgical treatment JBJS 33-A, 1951.

37.  TroisierO : Tennis elbow, Rev Prat 1991, Jun 21, 41(18), 1651-5.

38.  TurekS.L : Text book of Orthopeadics.

39.  Van Rossum J : Tennis Elbow - A radial tunnel syndrome JBJS 60-B 1978.

40.  Verhear J, Walenkemp.G, Kester A, Van Memoren H, VendrCiden

41.  T : Lateral release for tennis elbow - A prospective long term study JBJS Am 1993 July 75(5) : 1034-43.

42.  Wadsworth - The Elbow 1982.

43.  Wanivenhaus. A - Differential diagnosis of epicondylitishumeriradialis Z Orthop 1986 Nov-Dec, 124(6), 775-9.

44.  Withenbeg R.H, Scheal.S, Muhr G : Surgical treatment of persistent elbowepicondylitis ClinOrthop 1992 May; (278) : 73-80.

45.  Yerger B, Turner T : Percutaneous extensor tenotomy for chronic tennis elbow - an office procedure, Orthopaedics 1985 Oct, 8(10), 1261-3. 

Corresponding Author

Dr Sabarisree M

Associate Professor (CAP) in Orthopaedics,

Govt Medical College, Thiruvananthapuram