Skip to main content
SpringerLink
Log in

Minimally Invasive Approaches for Lateral Epicondylitis

  • Chapter
  • First Online:
Minimally Invasive Surgery in Orthopedics

  • 1864 Accesses

Abstract

Lateral epicondylitis is a painful condition that affects the lateral aspect of the elbow, usually centered around the epicondyle of the humerus. Historically called tennis elbow, this condition occurs in both men and women, usually in the 35- to 50-year age range, and rarely in tennis players. Patients present with laterally based elbow pain, exacerbated with repetitive stresses to the wrist and finger extensors, specifically the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). A distinct pathoetiology has not been elucidated, and as such most patients have an idiopathic source, although some patients report “work-related” causes. Direct trauma is rarely a source of tennis elbow pain, neither is tennis, as only 5–10% of patients with lateral epicondylitis are tennis players.1 Most patients report an insidious onset with pain associated with gripping, carrying, and holding objects with the forearm in pronation and the elbow in extension.

The natural history of tennis elbow is that it will usually resolve over time, but often with a protracted course. Numerous nonoperative and operative modalities to treat lateral epicondylitis have been described in the literature, although determining the “best” treatment is difficult if not impossible based on the literature.1–15 Currently, most patients who are indicated for operative treatment of their painful tennis elbow are managed with one of two procedures, a formal open release, as described originally by Hohmann, and modified by Nirschl, or an arthroscopic release.6,9 A review of the literature will reveal support for both open and arthroscopic techniques, and until a well-designed prospective, randomized trial comparing these techniques is available, many surgeons are guided by “their subjective viewpoint and clinical experience.”16 As such, we will describe the open and the arthroscopic procedures to treat patients with tennis elbow, both of which adhere to the principles of minimally invasive procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 349.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Assendelft WJ, Hay EM, Adshead R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract 1996;46(405):209–216

    CAS  PubMed  Google Scholar 

  2. Bosworth DM. The role of the orbicular ligament in tennis elbow. J Bone Joint Surg Am 1955;37-A(3):527–533

    CAS  PubMed  Google Scholar 

  3. Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br 2004;86(5):701–704

    Article  CAS  PubMed  Google Scholar 

  4. Haker E, Lundeberg T. Pulsed ultrasound treatment in lateral epicondylalgia. Scand J Rehabil Med 1991;23(3):115–118

    CAS  PubMed  Google Scholar 

  5. Harding W. Use and misuse of the tennis elbow strap. Phys Sportsmed 1992;20:65–74

    Google Scholar 

  6. Hohmann G. Das Wesen und die Behandlung des sogenannten Tennisellbogens. Munch Med Wochesnschr 1933;80:250–252

    Google Scholar 

  7. Molsberger A, Hille E. The analgesic effect of acupuncture in chronic tennis elbow pain. Br J Rheumatol 1994;33(12):1162–1165

    Article  CAS  PubMed  Google Scholar 

  8. Mullett H, Sprague M, Brown G, Hausman M. Arthroscopic treatment of lateral epicondylitis: clinical and cadaveric studies. Clin Orthop Relat Res 2005;439:123–128

    Article  CAS  PubMed  Google Scholar 

  9. Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979;61(6A):832–839

    CAS  PubMed  Google Scholar 

  10. Peart RE, Strickler SS, Schweitzer KM, Jr. Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop 2004;33(11):565–567

    PubMed  Google Scholar 

  11. Price R, Sinclair H, Heinrich I, Gibson T. Local injection treatment of tennis elbow - hydrocortisone, triamcinolone and lignocaine compared. Br J Rheumatol 1991;30(1):39–44

    Article  CAS  PubMed  Google Scholar 

  12. Rompe JD, Hopf C, Kullmer K, Heine J, Burger R, Nafe B. Low-energy extracorporal shock wave therapy for persistent tennis elbow. Int Orthop 1996;20(1):23–27

    Article  CAS  PubMed  Google Scholar 

  13. Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 2002;359(9307):657–662

    Article  CAS  PubMed  Google Scholar 

  14. Vasseljen O, Jr, Hoeg N, Kjeldstad B, Johnsson A, Larsen S. Low level laser versus placebo in the treatment of tennis elbow. Scand J Rehabil Med 1992;24(1):37–42

    PubMed  Google Scholar 

  15. Verhaar J, Walenkamp G, Kester A, van Mameren H, van der Linden T. Lateral extensor release for tennis elbow. A prospective long-term follow-up study. J Bone Joint Surg Am 1993;75(7):1034–1043

    CAS  PubMed  Google Scholar 

  16. Boyer MI, Hastings H, II. Lateral tennis elbow: “Is there any science out there?” J Shoulder Elbow Surg 1999;8(5):481–491

    Article  CAS  PubMed  Google Scholar 

  17. Cohen MS, Hastings H, II. Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Joint Surg Am 1997;79(2):225–233

    Article  CAS  PubMed  Google Scholar 

  18. Kalainov DM, Cohen MS. Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases. J Bone Joint Surg Am 2005;87(5):1120–1125

    Article  PubMed  Google Scholar 

  19. Morrey BF. Reoperation for failed treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg 1992;1:47–55

    Article  Google Scholar 

  20. Bosworth DM. Surgical treatment of tennis elbow; a follow-up study. J Bone Joint Surg Am 1965;47(8):1533–1536

    CAS  PubMed  Google Scholar 

  21. Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992;11(4):851–870

    CAS  PubMed  Google Scholar 

  22. Potter HG, Hannafin JA, Morwessel RM, DiCarlo EF, O’Brien SJ, Altchek DW. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology 1995;196(1):43–46

    CAS  PubMed  Google Scholar 

  23. Regan W, Wold LE, Coonrad R, Morrey BF. Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 1992;20(6):746–749

    Article  CAS  PubMed  Google Scholar 

  24. Antuna SA, O’Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy 2001;17(5):491–495

    Article  CAS  PubMed  Google Scholar 

  25. Duparc F, Putz R, Michot C, Muller JM, Freger P. The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow. Surg Radiol Anat 2002;24(5):302–307

    Article  CAS  PubMed  Google Scholar 

  26. Solveborn SA, Buch F, Mallmin H, Adalberth G. Cortisone injection with anesthetic additives for radial epicondylalgia (tennis elbow). Clin Orthop Relat Res 1995;(316):99–105

    PubMed  Google Scholar 

  27. Khashaba A. Nirschl tennis elbow release with or without drilling. Br J Sports Med 2001;35(3):200–201

    Article  CAS  PubMed  Google Scholar 

  28. Zingg PO, Schneeberger AG. Debridement of extensors and drilling of the lateral epicondyle for tennis elbow: a retrospective follow-up study. J Shoulder Elbow Surg 2006;15(3):347–350

    Article  PubMed  Google Scholar 

  29. Kaminsky SB, Baker CL, Jr. Lateral epicondylitis of the elbow. Tech Hand Up Extrem Surg 2003;7(4):179–189

    Article  PubMed  Google Scholar 

  30. Stapleton TR, Baker, CL. Arthroscopic treatment of lateral epicondylitis: a clinical study [abstract]. Arthroscopy 1996;12:365–366

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Mount Sinai School of Medicine, One Gustave Levy Place, 1188, New York, NY, 10029, USA

    Bradford O. Parsons & Michael R. Hausman

Authors
  1. Bradford O. Parsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael R. Hausman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradford O. Parsons .

Editor information

Editors and Affiliations

  1. Insall Scott Kelly Institute, East 64th St. 210, New York, 10021, U.S.A.

    Giles R. Scuderi

  2. Orthopaedic Center of New Jersey, Route 27 1527, Somerset, 08873, U.S.A.

    Alfred J. Tria

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Parsons, B.O., Hausman, M.R. (2010). Minimally Invasive Approaches for Lateral Epicondylitis. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-76608-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-76608-9_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-76607-2

  • Online ISBN: 978-0-387-76608-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation