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. 2011 Mar 16;2011(3):CD003525.
doi: 10.1002/14651858.CD003525.pub2.

Surgery for lateral elbow pain

Rachelle Buchbinder  1 , Renea V Johnston, Les Barnsley, Willem Jj Assendelft, Simon N Bell, Nynke Smidt
Affiliations

Surgery for lateral elbow pain

Rachelle Buchbinder et al. Cochrane Database Syst Rev. .

Abstract

Background: Surgery is sometimes recommended for persistent lateral elbow pain where other less invasive interventions have failed.

Objectives: To determine the benefits and safety of surgery for lateral elbow pain.

Search strategy: We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science unrestricted by date or language (to 15 December 2010).

Selection criteria: Randomised and controlled clinical trials assessing a surgical intervention compared with no treatment or another intervention including an alternate surgical intervention, in adults with lateral elbow pain.

Data collection and analysis: Two authors independently selected trials for inclusion, assessed risk of bias and extracted data.

Main results: We included five trials involving 191 participants with persistent symptoms of at least five months duration and failed conservative treatment. Three trials compared two different surgical procedures and two trials compared surgery to a non-surgical treatment. All trials were highly susceptible to bias. Meta-analysis was precluded due to differing comparator groups and outcome measures. One trial (24 participants) reported no difference between open extensor carpi radialis brevis (ECRB) surgery and radiofrequency microtenotomy, although reanalysis found that pain was significantly lower in the latter group at three weeks (MD -2.80 points on 10 point scale, 95% CI -5.07 to -0.53). One trial (26 participants) reported no difference between open ECRB surgery and decompression of the posterior interosseous nerve in terms of the number of participants with improvement in pain pain on activity, or tenderness on palpation after an average of 31 months following surgery. One trial (45 participants) found that compared with open release of the ERCB muscle, percutaneous release resulted in slightly better function. One trial (40 participants) found comparable results between open surgical release of the ECRB and botulinum toxin injection at two years, although we could not extract any data for this review. One trial (56 participants) found that extracorporeal shock wave therapy (ESWT) improved pain at night compared with percutaneous tenotomy at 12 months (MD 5 points on 100 point VAS, 95% CI 1.12 to 8.88), but there were no differences in pain at rest or pain on applying pressure.

Authors' conclusions: Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain. Further well-designed randomised controlled trials and development of standard outcome measures are needed.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Open ECRB release versus percutaneous ECRB tenotomy, Outcome 1 Mean DASH basic score at 12 months (0‐100 scale).
1.2
1.2. Analysis
Comparison 1 Open ECRB release versus percutaneous ECRB tenotomy, Outcome 2 Mean DASH sport score at 12 months (0‐100 scale).
1.3
1.3. Analysis
Comparison 1 Open ECRB release versus percutaneous ECRB tenotomy, Outcome 3 Mean DASH high performance work score at 12 months (0‐100 scale).
1.4
1.4. Analysis
Comparison 1 Open ECRB release versus percutaneous ECRB tenotomy, Outcome 4 Mean time to return to work (weeks).
2.1
2.1. Analysis
Comparison 2 Open ECRB release versus radiofrequency microtenotomy, Outcome 1 Mean pain score (0‐10 VAS).
2.2
2.2. Analysis
Comparison 2 Open ECRB release versus radiofrequency microtenotomy, Outcome 2 Function at 12 weeks (0‐100 MEPS scale).
2.3
2.3. Analysis
Comparison 2 Open ECRB release versus radiofrequency microtenotomy, Outcome 3 Grip strength at 12 weeks (kg).
3.1
3.1. Analysis
Comparison 3 Open ECRB lengthening versus PIN decompression, Outcome 1 Proportion with lateral elbow pain on activity.
3.2
3.2. Analysis
Comparison 3 Open ECRB lengthening versus PIN decompression, Outcome 2 Proportion with tenderness on palpation of lateral epicondyle.
3.3
3.3. Analysis
Comparison 3 Open ECRB lengthening versus PIN decompression, Outcome 3 Proportion with tenderness on palpation over PIN.
4.1
4.1. Analysis
Comparison 4 Percutaneous tenotomy versus ESWT, Outcome 1 Mean pain at night at 12 months (0‐100 point VAS).
4.2
4.2. Analysis
Comparison 4 Percutaneous tenotomy versus ESWT, Outcome 2 Mean pain at rest at 12 months (0‐100 VAS).
4.3
4.3. Analysis
Comparison 4 Percutaneous tenotomy versus ESWT, Outcome 3 Mean pain on pressure at 12 months (0‐100 VAS).
4.4
4.4. Analysis
Comparison 4 Percutaneous tenotomy versus ESWT, Outcome 4 Mean pain on Thomsen test at 12 months (0‐100 VAS).
4.5
4.5. Analysis
Comparison 4 Percutaneous tenotomy versus ESWT, Outcome 5 Mean pain on chair test at 12 months (0‐100 VAS).
4.6
4.6. Analysis
Comparison 4 Percutaneous tenotomy versus ESWT, Outcome 6 Proportion with treatment success at 12 months.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

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