Lateral Epicondyle Debridement Technique
synonyms: Lateral Epicondyle Debridement Technique
Lateral Epicondylitis Technique CPT
- 24357 (tenotomy elbow, lateral or medial; percutaneous)
- 24358 (tenotomy elbow, lateral or medial; debridement, soft tissue and/or bone; open)
- 24359 (tenotomy elbow, lateral or medial; debridement, soft tissue and/or bone; open with tendon repair or reattachment)
Lateral Epicondylitis Technique Indications
- Debilitating pain affecting ADL’s, localized precisely to lateral epicondyle and ECRB/EDC origin, which has failed a well-managed nonoperative program for a minimum of 6-12 months.
Lateral Epicondylitis Technique Contraindications
- Other pathologic causes for lateral elbow pain
Lateral Epicondylitis Technique Alternatives
- Arthroscopic debridement (Owens BD, Arthroscopy 2001;17:582).
- Percutaneous debridement (1cm incision over lateral epicondyle; division of common extensor origin; wrist flexion to complete common extensor division) (Dunkow PD, JBJS 2004;86Br:701).
- Many techniquescurrent=extra-articular excision of pathologic portion of ECRB, repair of defect and reattachment to epicondyle
Lateral Epicondylitis Technique Pre-op Planning / Special Considerations
Lateral Epicondylitis Technique Technique
- Pre-operative antibiotics, +/- regional block
- General endotracheal anesthesia
- position. All bony prominences well padded.
- Examination under anesthesia.
- Prep and drape in standard sterile fashion.
- Close in layers.
- pre-op antibiotic
- supine with arm board, well-padded tourniquet high on arm
- prep and drape
- incision 1cm proximal and just anteromedial to lateral epicondyle to 1c, distal to epicondyle
- sq tissue incised and retracted
- locate interval between ECRL and firm anterior edge of extensor aponeurosis
- split interval to 2-3mm
- ECRL released by scapel dissection and retracted anterolaterally 2-3cm
- ECRB now in view appears dull-gray edematous and friable
- patholigc tissue was excised en bloc usually 2-1cm
- any exostosis removed with ronqeur and rasp
- 2-3 5/64 holes drilled in cortical bone in resected area
- ECRL / extensor aponeurosis interval closed with #1 PDS
- sq closed with 2-0 vicryl, skin 4-0 monocryl , mastisol, steri-strips
Lateral Epicondylitis Technique Complications
- Persistent pain of varying degree
- Residual strength deficit
- Functional limitations
- Joint instability
Lateral Epicondylitis Technique Follow-up care
- Rehab Protocol: wrist extensor stretching and progressive isometric exercises. Later begin eccentric and concentric exercises
- 26% of patients will have recurrence of symptoms and over 40% have prolonged minor discomfort. Other more optomisitic reports show 85-90% successful nonoperative treatment
- Surgery=posterior mold for 7-10days. Then progressive mobilization/gentle passive and active elbow, wrist, hand motion. Counterforce bracing for 3-6 months. Resisted isometrics at 4wks, progressive strengthening at 6 wks. Return to lifting/athletics usually by 3-4 month.
Lateral Epicondylitis Technique Outcomes
- 85-90% full activity without pain. 10-12% improvement but with some pain. 2-3% no improvement or worse.
- Szabo SJ, JSES 2006;15:721.
Lateral Epicondylitis Technique Review References