Abstract
Reoperative surgery for failed previous medial or lateral epicondylitis surgery can be quite challenging. One key concern is making sure that other structures are not actually the cause of persistent symptoms. In the case of medial epicondylitis, it is important to assess for possible medial antebrachial cutaneous nerve (MABCN) injury, ulnar neuropathy, or medial collateral ligament damage. These can sometimes be a source of continued symptomatology despite expertly performed medial epicondylitis surgery. One of the newer techniques for addressing failed or recurrent medial epicondylitis is medial epicondyle denervation surgery. This chapter delves into the surgical detail of this procedure. Similarly, for lateral epicondylitis, it is important to rule out evidence of persistent radial tunnel syndrome, radial capitellar joint plica or synovial fistula, as well as any damage to the lateral collateral ligament. In cases of true failed lateral epicondylitis surgery, a lateral epicondyle denervation surgery can be performed. This can be helpful in the patient who has had multiple previous surgeries. The other issue in treating patients with these conditions is trying to set a reasonable level of expectations regarding outcomes. This chapter details some of the newer techniques for treating these challenging clinical problems.
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Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6):832–9.
Suresh SPS, Ali KE, Jones H, Connell DA. Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med. 2006;40:935–9.
Hilburn JW. General principles and use of electrodiagnostic studies in carpal and cubital tunnel syndromes. Hand Clin. 1996;12:205–21.
Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elbow Surg. 2001;10(2):152–7.
Ahmad CS, Lee TQ, El Attrache NS. Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med. 2003;31(3):332–7.
Wilhelm A. ZurEntwicklungsgeschichte der gelenke der oberen extrmitat. Z Anatomieund Entwicklungsgesch. 1958;120:331–71.
Dellon AL, Ducic I, DeJesus RA. Innervation of the medial humeral epicondyle: implications for medial epicondylar pain. J Hand Surg Br. 2006;31(3):331–3.
Wilhelm A. Tennis elbow: treatment of resistant cases by denervation. J Hand Surg Br. 1996;21(4):523–33.
Rineer CA, Ruch DS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am. 2009;34(3):566–76.
Regan W, Wold LE, Coonrad R, Morrey BF. Microscopic histopathology of lateral epicondylitis. Am J Sports Med. 1992;20:746–9.
Nirschl RP, Ashman E. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003;22:813–36.
Dorf ER, Chhabra AB, Golish SR, McGinty JL, Pannunzio ME. Effect of elbow position on grip strength in the evaluation of lateral epicondylitis. J Hand Surg Am. 2007;32(6):882–6.
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):1120–5.
Savnik A, Jensen B, Norregaard J, Egund N, Danneskiold-Samsoe B, Bliddal H. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol. 2004;14:964–9.
Smidt N, van der Windt DAWM, Assendelft WJJ, Deville WLJM, Korthals-de Bos IBC, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet. 2002;359:657–62.
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am. 2003;28(2):272–8.
Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol. 2006;35:371–7.
Staples MP, Forbes A, Ptasznik R, Gordon J, Buchbinder R. A randomized controlled study of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol. 2008;35:2038–46.
Rose NE. Partial lateral denervation for lateral epicondylitis. Presented at the American Society for Peripheral Nerve Conference. Boca Raton, FL; 2010
Dellon AL. Partial joint denervation I: wrist, shoulder and elbow. Plast Reconstr Surg. 2009;123(1):197–207.
Gardner E. The innervation of the elbow joint. Anat Rec. 1947;100:341–6.
Werner CO. Lateral elbow pain and posterior interosseous nerve entrapment. Acta Orthop Scand Suppl. 1979;174:1–62.
Nestor BJ, O’Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1992;74(8):1235–41.
Schmidt CC, Kohut GN, Greenberg JA, Kann SE, Idler RS, Kiefhaber TR. The anconeus muscle flap: its anatomy and clinical application. J Hand Surg Am. 1999;24A(2):359–69.
Basmajian JV, Griffin Jr WR. Function of anconeus muscle: an electromyographic study. J Bone Joint Surg Am. 1972;54(8):1712–4.
Morrey BF. Reoperation for failed surgical treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg. 1992;1:47–55.
Regan W, Lapner PC. Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. J Shoulder Elbow Surg. 2006;15(3):344–6.
Sanchez-Sotelo J, Morrey BF, O’Driscoll SW. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br. 2005;87(1):54–61.
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Rose, N.E. (2012). Reoperative Medial and Lateral Epicondylitis Surgery. In: Duncan, S. (eds) Reoperative Hand Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2373-7_20
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