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Lateral Epicondylitis Surgery Workup

  • Author: Brett D Owens, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Mar 04, 2015
 

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) origin can be seen in chronic cases.[8]

Magnetic resonance imaging (MRI) can help confirm the presence of degenerative tissue in the ECRB origin and can help diagnose concomitant pathology. A guideline from the American College of Radiology (ACR) recommended 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 (EMG) 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 ECRB can help confirm the diagnosis; patients should experience symptomatic relief with such injections.

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Histologic Findings

Despite the implication of the term lateral epicondylitis, the histology of the lesions shows neither acute nor chronic inflammatory cell infiltrate; thus, the term is actually a misnomer. The 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 of lateral epicondylitis:

  • Stage 1 - Inflammatory changes that are reversible
  • Stage 2 - Nonreversible pathologic changes to the origin of the ECRB
  • Stage 3 - Rupture of the origin of the ECRB
  • Stage 4 - Secondary changes, such as fibrosis or calcification
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Contributor Information and Disclosures
Author

Brett D Owens, MD Professor of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of Health Sciences; Assistant Professor of Orthopedic Surgery, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Chief of Orthopedic Surgery, Keller Army Hospital

Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Orthopaedic Trauma Association, Society of Military Orthopaedic Surgeons

Disclosure: Received consulting fee from Musculoskeletal Transplant Foundation for consulting; Received consulting fee from Johnson & Johnson (MITEK) for consulting; Received royalty from SLACK Publishing for other; Received salary from American Journal of Sports Medicine for employment.

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

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

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

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, Clinical Professor, Surgery, Nova Southeastern 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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

Timothy R Kuklo, MD, JD Associate Professor, Department of Surgery, Uniformed Services University of the Health Sciences

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.

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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.
Origin of extensor carpi radialis brevis exposed.
Lateral epicondylitis. Osteotome positioned over lateral epicondyle.
 
 
 
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