Denervation of the Lateral Epicondyle for the Treatment of Chronic Lateral Epicondylitis
DOI:
https://doi.org/10.21270/archi.v11i1.5616Keywords:
Elbow Joint, Tennis Elbow, DenervationAbstract
Introduction: lateral epicondylitis is a chronic-degenerative process that affects the origin of the extensor muscles of the wrist and fingers. Its treatment is carried out conservatively, achieving good results. However, some cases evolve unfavorably, requiring surgical intervention. Surgical denervation is one of the management options already described in the literature. However, few studies on this technique are available in the national context. Aim of the study: To evaluate the denervation in the management of chronic lateral epicondylitis. Methods: retrospective study analyzing 12 patients undergoing lateral epicondyle denervation. Preoperative testing included anesthetic injection as a predictor of results. The patients underwent denervation of the posterior branch(s) of the posterior cutaneous nerve of the forearm through a lateral incision in the distal third of the arm. Pre and postoperative clinical assessment of patients was performed using the Quick DASH and VAS questionnaire. Results: The Quick DASH result was 78.7 points in the preoperative evaluation and 28.9 in the postoperative evaluation (p=0.001). The preoperative VAS result was 7.58 points and 4.2 points in the postoperative evaluation (p=0.02). Conclusions: We conclude that the lateral epicondyle denervation technique has satisfactory outcomes. However, more studies are needed to evaluate the technique better.
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References
Cohen M, Filho GRM. Epicondilite lateral do cotovelo. Rev Bras Ortop. 2012;47(4):414-20
Lech O, Piluski PCF, Severo AL. Epicondilite lateral do cotovelo. Rev Bras Ortop, 2003;38(8):421-36.
Nirschl RP. Elbow tendinosis / tennis elbow. Clin Sports Med. 1992;11(4):851-70
Nirschl RP. Muscle and tendon trauma: tennis elbow tendinosis in: Morrey B F, The Elbow and its disorders, 3a ed. Philadelphia, Saunders, 2000, 523-535.
Dojode CM. A randomised control trial to evaluate the efficacy of autologous blood injection versus local corticosteroid injection for treatment of lateral epicondylitis. Bone Joint Res. 2012;1(8):192-97.
Kertzman P, Lenza M, Pedrinelli A, Ejnisman B. Tratamento por ondas de choque nas doenças musculoesqueléticas e consolidação óssea - Análise qualitativa da literatura. Rev Bras Ortop. 2015;50(1):3-8.
Wong SM, Hui AC, Tong PY et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2005;143(11):793-97
Gardner E. The innervation of the elbow joint. Anat Rec. 1948;102(2):161-74.
Wilhelm A. Die Behandlung der Epicondylitis humeri radialis durch Dekompression des N. radialis [Management of epicondylitis humeri radialis through the decompression of the radial nerve]. Handchirurgie. 1977;9(4):185-87.
Hayton MJ, Santini AJ, Hughes PJ, Frostick SP, Trail IA, Stanley JK. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am. 2005;87(3):503-7.
Medina GEIS, Roselis DG, Sano M et al. Tratamento da epicondilite lateral do cotovelo por mini incisão. Rev Bras Ortop Iustr. 2011;2(2):43-52.
Miazaki A, Fregonese M, Santos PD et al. Avaliação dos resultados do tratamento artroscópico da epicondilite lateral. Rev Bras Ortop. 2010;45(2):136-40.
Pierce TP, Issa K, Gilbert BT et al. A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin. Arthroscopy. 2017;33(6):1260-68.
Solheim E, Hegna J, Øyen J. Arthroscopic versus open tennis elbow release: 3- to 6-year results of a case-control series of 305 elbows. Arthroscopy. 2013;29(5):854-59
Carofino BC, Bishop AT, Spinner RJ, Shin AY. Nerve injuries resulting from arthroscopic treatment of lateral epicondylitis: report of 2 cases. J Hand Surg Am. 2012;37(6):1208-10.
Rose NE, Forman SK, Dellon AL. Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis. J Hand Surg Am. 2013;38(2):344-49.
Berry N, Neumeister MW, Russell RC, Dellon AL. Epicondylectomy versus denervation for lateral humeral epicondylitis. Hand (N Y). 2011;6(2):174-8.
Smidt N, van der Windt DA, Assendelft WJ et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-62
Mattie R, Wong J, McCormick Z, Yu S, Saltychev M, Laimi K. Percutaneous Needle Tenotomy for the Treatment of Lateral Epicondylitis: A Systematic Review of the Literature. PM R. 2017;9(6):603-11.
Kaplan EB. Treatment of tennis elbow (epicondylitis) by denervation. J Bone Joint Surg Am. 1959;41-A(1):147-51.
Wilhelm A. Tennis elbow: treatment of resistant cases by denervation. J Hand Surg Br. 1996;21(4):523-33.
