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Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis

PainSci » bibliography » Rose et al 2013
updated
Tags: surgery, denervation, tendinosis, elbow, treatment, neurology, pain problems, overuse injury, injury, arm, limbs

Five articles on PainSci cite Rose 2013: 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 Rose 2013: ?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 wherever possible.

A small test of treating tennis elbow by destroying nerve supply (in patients who had already responded well to a nerve block): “80% of patients had good or excellent results, as defined by an improvement of 5 or more points” on a pain scale to 10.

The test was not controlled by comparison of the treatment to a placebo, which is well-known to be essential for producing reliable results, particularly in surgery (see Louw), and so the authors’ conclusions must be taken with a 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.

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.

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