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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Kroslak 2012.

Disappointing first trial of surgery for tennis elbow

updated
Tags: treatment, surgery, tendinosis, pain problems, overuse injury, injury

PainSci summary of Kroslak 2012?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

Past studies have reported good results from surgery (eg: see Garden, Solheim), but this is probably the first ever placebo-controlled study of surgery for tennis elbow (lateral epicondylitis), and it had disappointing results.

Eleven patients were treated with the Nirschl technique (surgical excision of the macroscopically degenerated portion of ECRB), and 11 received a sham operation: a skin incision, exposing the tendon. Both groups improved equally: “The only difference observed between the groups was that patients who underwent the Nirschl procedure for tennis elbow had significantly more pain with activity at 2 weeks.” The author rather scathingly concludes: “There is no benefit to be gained from the gold standard tennis elbow surgery over placebo surgery in the management of chronic lateral epicondylitis. In fact, the Nirschl procedure may increase the morbidity of the condition in the immediate post-operative period.”

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Tennis elbow (lateral epicondylitis) is a common condition with a community prevalence of 1-3%, resulting in pain at the elbow and weakness extending the wrist. It is associated with overuse and if it progresses to a chronic stage, tennis elbow shows both macroscopic and microscopic degeneration at the origin of the extensor carpi radialis brevis (ECRB). While there is no universally effective management for chronic tennis elbow, a common surgical technique (Nirschl & Pettrone. J Bone Joint Surg Am, 61(6A): 832-839) involves cutting out the degenerated portion of the ECRB. The results of this technique have been reported as excellent, yet no surgical procedure for tennis elbow has been compared with placebo surgery.

METHODS: This study was a prospective, randomised, double-blinded, placebo controlled clinical trial investigating the Nirschl technique (surgical excision of the macroscopically degenerated portion of ECRB; n=11) compared with a sham operation (skin incision and exposure of ECRB alone; n=11) to treat chronic tennis elbow. The primary outcome measure was defined as patient rated elbow pain with activity at 6 months post-surgery. Secondary outcome measures included other patient rated pain and functional outcomes, elbow stiffness and range of motion, epicondyle tenderness and strength measurements.

RESULTS: The two groups were matched for age, gender and duration of symptoms. Both the Nirschl and sham procedures improved patient rated pain frequency and severity, elbow stiffness, difficulty with picking up objects and twisting motions and grip strength over 6 months (p<0.01). The only difference observed between the groups was that patients who underwent the Nirschl procedure for tennis elbow had significantly more pain with activity at 2 weeks, when compared with sham surgery alone (p<0.05). No side effects or complications were reported.

CONCLUSION: This pilot study indicates that, in the short term, surgical excision of the degenerative portion of ECRB confers no additional benefits to patients with chronic tennis elbow over and above a skin incision alone.

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This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: