Functional Outcome of Arthroscopic Extensor Carpi Radialis Brevis Tendon Release in Chronic Lateral Epicondylitis
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PURPOSE: To evaluate outcomes of arthroscopic tennis elbow release in a population of patients with chronic, recalcitrant symptoms, a large number of workers' compensation claims, and high occupational demands using standardized outcome measures, including a detailed objective assessment of workplace demands. METHODS: We treated 36 patients with chronic lateral epicondylitis with an arthroscopic release. A standardized protocol was used to measure strength, motion, and outcomes (American Shoulder and Elbow Surgeons Elbow [ASES-e] score, Short Form-12, Patient-Rated Tennis Elbow evaluation [PRTEE], and Work Limitations Questionnaire-26). RESULTS: The mean duration of symptoms before surgery was 30 months. A total of 25 of 36 patients were employed in heavy or repetitive occupations and 23 of 36 were involved in a workers' compensation claim. The final overall results were favorable, with 30 of 36 subjects reporting improvement with surgery. The final mean Mayo Elbow Performance Index score was 78.6 +/- 16.5 (22 = good to excellent, 9 = fair, and 5 = poor). The average total PRTEE was 26.2 +/- 24.3 out of 100. The average ASES-e pain score was 16.1 +/- 15.0 and the average ASES-e function score was 27.9 +/- 8.8. Patients in heavy or repetitive occupations and those with workers' compensation claims had significantly worse outcome scores (Mayo Elbow Performance Index, ASES, and PRTEE). Based on Work Limitations Questionnaire-26 scores, patients with workers' compensation claims had significantly greater difficulties with physical (36.8 vs 3.2, p < .001), output (40.8 vs 3.1, p = .002), mental (36.0 vs 9.0, p = .05), and social (27.7 vs 6.3, p = .05) workplace demands. CONCLUSIONS: Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. Patient selection and reported occupational demands have an important role in determining outcomes. More work is required to identify factors predicting outcome in this difficult subgroup.
