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Epicondylectomy versus denervation for lateral humeral epicondylitis

PainSci » bibliography » Berry et al 2011
Tags: treatment, denervation, neurology

Five articles on PainSci cite Berry 2011: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Patellofemoral Pain Syndrome3. Tennis Elbow Guide4. The Complete Guide to Neck Pain & Cricks5. Do Nerve Blocks Work for Neck Pain and Low Back Pain?

PainSci commentary on Berry 2011: ?This page is one of thousands in the 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 wherever possible.

A small test (30 subjects) of treating tennis elbow by destroying nerve supply to the affected tissue: “denervation gives significant relief from lateral humeral epicondylitis once traditional non-surgical treatment has failed.” The test was not controlled by comparison of the treatment to a placebo, which is essential for producing reliable results, particularly for surgery (see Louw), and so the conclusions must be taken with a large grain of salt.

~ Paul Ingraham

original abstract Abstracts 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: Traditional management of lateral humeral epicondylitis ("tennis elbow") relies upon antiinflammatory medication, rehabilitation, steroid injection, counterforce splinting, and, finally, surgery to the common extensor origin. The diversity of surgical approaches for lateral humeral epicondylitis (LHE) suggests perhaps that the ideal technique has not been determined. Denervation of the lateral humeral epicondyle is the concept of interrupting the neural pathway that transmits the pain message. Epicondylectomy may accomplish its relief of LHE by denervating the epicondyle.

METHODS: Since it is known that the posterior branch of the posterior cutaneous nerve of the forearm innervates the lateral humeral epicondyle, 30 patients who were treated surgically for refractory LHE were retrospectively evaluated. Group 1 consisted of 17 patients who were treated with epicondylectomy alone, group II consisted of seven patients who were treated with lateral epicondylectomy plus neurectomy, and group III consisted of seven patients treated with lateral denervation alone.

RESULTS: Denervation alone gave statistically significantly greater improvement in pain relief (p < 0.001) and statistically significantly faster return to work than did epicondylectomy alone (p < 0.001). Denervation plus epicondylectomy gave results that were the same as denervation alone.

CONCLUSION: It is concluded that denervation gives significant relief from LHE once traditional non-surgical treatment has failed.

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