Surgical treatment of lateral epicondylitis: a prospective, randomised, blinded, placebo controlled pilot study

Abstract

Background: Tennis elbow (lateral epicondylitis) is a common condition with a community prevalence of 1-3%, resulting in pain at the elbow and weakness extending the wrist. It is associated with overuse and if it progresses to a chronic stage, tennis elbow shows both macroscopic and microscopic degeneration at the origin of the extensor carpi radialis brevis (ECRB). While there is no universally effective management for chronic tennis elbow, a common surgical technique (Nirschl & Pettrone. J Bone Joint Surg Am, 61(6A): 832-839) involves cutting out the degenerated portion of the ECRB. The results of this technique have been reported as excellent, yet no surgical procedure for tennis elbow has been compared with placebo surgery.

Methods: This study was a prospective, randomised, double-blinded, placebo controlled clinical trial investigating the Nirschl technique (surgical excision of the macroscopically degenerated portion of ECRB; n=11) compared with a sham operation (skin incision and exposure of ECRB alone; n=11) to treat chronic tennis elbow. The primary outcome measure was defined as patient rated elbow pain with activity at 6 months post-surgery. Secondary outcome measures included other patient rated pain and functional outcomes, elbow stiffness and range of motion, epicondyle tenderness and strength measurements.

Results: The two groups were matched for age, gender and duration of symptoms. Both the Nirschl and sham procedures improved patient rated pain frequency and severity, elbow stiffness, difficulty with picking up objects and twisting motions and grip strength over 6 months (p<0.01). The only difference observed between the groups was that patients who underwent the Nirschl procedure for tennis elbow had significantly more pain with activity at 2 weeks, when compared with sham surgery alone (p<0.05). No side effects or complications were reported.

Conclusion: This pilot study indicates that, in the short term, surgical excision of the degenerative portion of ECRB confers no additional benefits to patients with chronic tennis elbow over and above a skin incision alone.