Epicondylectomy versus denervation for lateral humeral epicondylitis

Traditional management of lateral humeral epicondylitis ("tennis elbow") relies upon antiinflammatory medication, rehabilitation, steroid injection, counterforce splinting, and, finally, surgery to the common extensor origin. The diversity of surgical approaches for lateral humeral epicondylitis (LHE) suggests perhaps that the ideal technique has not been determined. Denervation of the lateral humeral epicondyle is the concept of interrupting the neural pathway that transmits the pain message. Epicondylectomy may accomplish its relief of LHE by denervating the epicondyle.

Since it is known that the posterior branch of the posterior cutaneous nerve of the forearm innervates the lateral humeral epicondyle, 30 patients who were treated surgically for refractory LHE were retrospectively evaluated. Group 1 consisted of 17 patients who were treated with epicondylectomy alone, group II consisted of seven patients who were treated with lateral epicondylectomy plus neurectomy, and group III consisted of seven patients treated with lateral denervation alone.

Denervation alone gave statistically significantly greater improvement in pain relief (p < 0.001) and statistically significantly faster return to work than did epicondylectomy alone (p < 0.001). Denervation plus epicondylectomy gave results that were the same as denervation alone.

It is concluded that denervation gives significant relief from LHE once traditional non-surgical treatment has failed.