LATERAL EPICONDYLE RELEASE: OPEN VS. ARTHROSCOPIC VS. PERCUTANEOUS

Lateral Epicondyle Release

Open vs. Arthroscopic vs. Percutaneous

G. Dexter Walcott, Felix H. Savoie III, and Larry D. Field

Lateral epicondylitis is a common and often debilitating cause of elbow pain. It has been classically associated with sports participation, especially tennis, but is now also a commonly recognized occupational disorder. Most commonly, lateral epicondylitis is the result of repetitive overuse injury, but an acute traumatic event is noted in some cases. Microscopic or macroscopic tears at the extensor tendon origin on the lateral epicondyle usually involving the extensor carpi radialis brevis occur as the initiating event. The healing attempt may result in fibrosis and granulation tissue instead of normal tendon. With repeated injuries, mucinoid degeneration and partial ruptures develop. The majority of patients (90%) can be successfully treated nonoperatively with nonsteroidal anti-inflammatory medications, braces, steroid injections, and physical therapy. When these measures fail, operative treatment may be indicated. Many procedures have been described to treat lateral epicondylitis. In this practice, open, arthroscopic, and percutaneous techniques are utilized.

Indications

Persistent pain despite aggressive nonoperative management.

Contraindications

1. Lack of an adequate trial of nonoperative management

2. Lack of clear clinical evidence of isolated lateral epicondylitis

Mechanisms of Injury

1. Repetitive overuse

2. Acute traumatic injury

Physical Examination

1. Tenderness at the extensor origin anterior to the lateral epicondyle

2. Pain with resisted wrist extension

Differential Diagnosis/Possible Coexisting Conditions

1. Posterior interosseous nerve compression

2. Symptomatic posterolateral plica

Radiographs

Anteroposterior/lateral radiographs of elbow may show calcification at extensor origin or intraarticular pathology, but are typically normal.

Procedures

1. Percutaneous release—can be performed in office

2. Open release

3. Arthroscopic release

Choice of Procedure

Patients who agree to an in-office procedure and do not have associated elbow pathology are candidates for percutaneous release. Patients who desire an in-hospital procedure or who have associated elbow pathology are candidates for open or arthroscopic release.

Special Instruments

1. Arthroscopic release

2. Standard elbow arthroscopy equipment

3. Arthroscopic shaver

4. Monopolar radio frequency probe with ligament chisel attachment

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