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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
  • Infection

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 techniques—current=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.
  • Irrigate.
  • Close in layers.
  • pre-op antibiotic
  • supine with arm board, well-padded tourniquet high on arm
  • anesthesia
  • 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
  • Infection
  • 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

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