Lateral Epicondyle Debridement 24358

elbow lateral image

elbow cross section image

synonyms: Lateral Epicondyle Debridement Technique

Lateral Epicondylitis Technique CPT

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-op antibiotic, operative site marked pre-operatively
    • LMA vs general anethesia vs regional block
    • supine with arm board, well-padded tourniquet high on arm
    • all bony prominences well padded
    • 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
    • irrigate
    • 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

    • Lateral Epicondylitis 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