Lateral Epicondylitis Surgery Workup

  • Author: Brett D Owens, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jul 22, 2011
 

Imaging Studies

  • Radiographs can be helpful in ruling out other disorders or concomitant intra-articular pathology (eg, osteochondral loose body, posterior osteophytes). Calcification in the degenerative tissue of the extensor carpi radialis brevis (ECRB) muscle origin can be seen in chronic cases.[8]
  • Magnetic resonance imaging can help confirm the presence of degenerative tissue in the ECRB muscle origin and can help diagnose concomitant pathology. A guideline from the American College of Radiology (ACR) recommends MRI as the most appropriate imaging study for patients with suspected chronic epicondylitis when radiographs are nondiagnostic.[9] The ACR considers ultrasonography of the elbow a reasonable alternative to MRI if expertise is available. However, these imaging studies are very rarely needed.,
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Other Tests

  • If the clinical examination indicates a possible neural etiology for the patient's symptoms, electromyography can be helpful in excluding posterior interosseous nerve compression syndrome as the diagnosis.
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Diagnostic Procedures

  • Anesthetic injections into the origin of the extensor carpi radialis brevis (ECRB) muscle can help confirm the diagnosis, as the patient should experience relief from symptoms.
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Histologic Findings

Despite the misnomer of lateral epicondylitis (tennis elbow), the histology of lesions shows neither acute nor chronic inflammatory cell infiltrate. Lesions are characterized by fibroblastic invasion with neovascularization. One study noted mesenchymal cell proliferation indicative of a healing process. However, most other studies indicate degenerative changes.[10]

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Staging

Nirschl defined the following progressive stages:

  • Stage 1 - Inflammatory changes that are reversible
  • Stage 2 - Nonreversible pathologic changes to origin of the extensor carpi radialis brevis (ECRB) muscle
  • Stage 3 - Rupture of ECRB muscle origin
  • Stage 4 - Secondary changes such as fibrosis or calcification
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Brett D Owens, MD  Associate Professor of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of Health Sciences

Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Society of Military Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer Moriatis Wolf, MD  Associate Professor, Department of Orthopedic Surgery, University of Connecticut Health Center

Jennifer Moriatis Wolf, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Kevin P Murphy, MD  Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Director, Sports Medicine, Department of Orthopedic Surgery and Rehabilitation, Walter Reed Army Medical Center

Kevin P Murphy, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark D Lazarus, MD  Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas R Hunt III, MD  John D Sherrill Professor and Director of Orthopedic Surgery, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham School of Medicine; Surgeon-in-Chief, UAB Highlands Hospital

Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association

Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None; Lippincott Royalty Independent contractor

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of Dr. Timothy Kuklo to the development and writing of this article.

References

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  18. Haake M, König IR, Decker T, Riedel C, Buch M, Müller HH. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am. Nov 2002;84-A(11):1982-91. [Medline].

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Type I lateral epicondylitis seen through the 30° arthroscope.
Type 2 lateral epicondylitis showing a linear tear in the origin of the extensor carpi radialis brevis muscle.
Type 3 lateral epicondylitis showing a large tear in the origin of the extensor carpi radialis brevis muscle.
Representation of the relationships in arthroscopic release for lateral epicondylitis
Lateral epicondylitis. Incision for open debridement of lateral epicondyle. Lateral epicondyle is circled.
Revision debridement for lateral epicondylitis. The fascia covering the origin of the extensor carpi radialis brevis muscle and the extensor carpi radialis longus muscle is fibrotic.
The extensor origin exposed
Lateral epicondylitis. Osteotome positioned over lateral epicondyle.
 
 
 
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