Article
Long Term Outcomes of Medial Epicondylectomies
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Authors
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Libby J. Anderson
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
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Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: We hypothesized that medial epicondylectomy is a safe and effective method to treat medial epicondylitis and ulnar neuritis, with good medium to long-term patient outcomes.
Methods: This is a study of a consecutive sample of 29 patients who underwent medial epicondylectomy and were assessed preoperatively and at 3 & 6 months and 2, 3, 4 or 5 years after surgery. 2 patients had medial epicondylectomy alone and 27 patients also had ulnar neurolysis, 7 of whom had additional procedures such as removal of osteophytes (2 patients), debridement (2 patients), biopsy (1 patient), medial collateral ligament reconstruction (1 patient) or removal of plate (1 patient). 7 participants (24.1%) were female and 12 (41.4%) had surgery on the dominant side. Median patient's age at surgery was 49 (range 24 - 75) and median follow-up time was 12 months (range 3 - 60 months).
We measured pain and satisfaction (Visual Analogue Scale), Patient-Rated Elbow Evaluation (PREE), function (QuickDASH), Global Rating of Change (GRC), and grip and pinch strength. Results are reported as median (25% - 75%). Comparisons are made between preoperative values (n=28) and one year after surgery (n=14) or last follow-up equal or greater than 2 years (n=8).
Results and Conclusions: Pain decreased from 46.5 (9.8 - 66.5) before surgery to 7.5 (3.8 - 26.5) at last follow-up, whereas satisfaction increased from 15.0 (5.3 - 51.3) to 90.0 (53.3 - 95.3). Function scores improved from baseline values of 43.7 (20.4 - 57.8) for PREE and 54.5 (22.2 - 64.2) for QuickDASH to 17.0 (7.2 - 37.8) and 20.5 (17 - 37.8) respectively at last follow-up. GRC scores for symptoms and function increased throughout the time course from 3 (1 - 5) and 3 (1 - 4) respectively at 3 months after surgery to 5 (3 - 7) and 4 (0 - 6) at last follow-up equal or greater than 2 years.
Range of motion increased slightly with flexion shifting from 135° (130 - 144) to 140 (138 - 149), extension from 0° (-2.5 - 5.5) to 6° (0 - 20.3), supination from 80° (77 - 85) to 85° (77.5 - 97.5), and pronation from 85° (75 - 90) to 82.5° (75.5 - 85). Grip and pinch strength tended also to increase from 31.3 (16.5 - 45.5) to 37.4 (36.8 - 48.3) kg in grip, 5.4 (4.0 - 7.6) to 6.5 (4.4 - 8.9) kg in lateral pinch strength and 4.0 (3.0 - 4.6) to 5.1 (3.5 - 5.8) kg in tip-to-tip pinch strength.
These results, combined with those fom the literature, suggest that medial epicondylectomy is a safe and effective procedure to treat medial epicondylitis and ulnar neuritis.
