gms | German Medical Science

Objectives/Interrogation: To report on the clinical outcome of the open treatment of the recalcitrant lateral epicondylitis and the postoperative change of the ECRB tendon status using ultrasonography

Methods: Included in this study were 38 patients (10 male, 28 female; mean age, 51.8 years) who underwent the open excision of the degenerative portion of the ECRB for their recalcitrant lateral epicondylitis. Preoperative ultrasonography was performed in all patients. Postoperative ultrasonography was performed at 4 to 6 months (31 patients) and one year (20 patients). The mean follow-up duration was 12.4 (range, 4-40) months. On ultrasonography, preoperative tendon status was classified into three types according to the pattern of the fibrillar disruption (diffuse intrasubstance tear, deep focal defect, large intrasubstance defect). Postoperative ultrasonographic change was recorded according to the degree of restoration of the fibrillar pattern (minimal, moderate, complete). Tendon thickness was also recorded at each time of the ultrasonography and the change was compared. For a functional evaluation, Visual Analogue Scale (VAS) pain score, The Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient-Rated Elbow Evaluation (PREE) score were recorded and compared with the preoperative Data.

Results and Conclusions: At final follow up, VAS improved from a preoperative mean of 4.2 (at rest), 5.7 (at daily living activities) and 8.9 (at sports or occupational activities) to a postoperative mean of 0.3, 1.3 and 2.3, respectively (P <.001). DASH and PREE also improved significantly from a preoperative mean of 59, 130 to a postoperative mean of 4, 29 respectively (P < .001). Preoperative ultrasonography revealed hypoechoic area and swelling and the disruption of the fibrillar pattern of the ECRB origin in all patients (diffuse intrasubstance tear 17; deep focal defect 12; large intrasubstance defect 9). Preoperative mean of the tendon thickness was 6.2 mm at long axis and 5.6 mm at short axis. At postoperative 4 to 6 months, tendon thickness increased to 7 mm and 6.7 mm but decreased to 6.2 mm and 5.9 mm at postoperative one year. Of 20 patients with ultrasonography at one year, the degree of restoration of the fibrillar pattern was minimal 0, moderate 8 and complete 12. Conclusively,open treatment of the recalcitrant lateral epicondylitis yielded satisfactory clinical improvement. Postoperative follow-up ultrasonography showed restoration of the fibrillar pattern and the change of the ECRB tendon thickness.