The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

Not yet assigned to a slot - 3:20 AM

Denervation of the Lateral Humeral Epicondyle For the Treatment of Refractory Tennis Elbow

Ducic I1, DeJesus RA2, and Dellon AL2. (1) Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, USA, (2) Plastic Surgery, Institute for Peripheral Nerve Surgery, Johns Hopkins University, 3333 North Calvert Street, Suite 370, Baltimore, MD, USA

The current surgical techniques for treatment of tennis elbow rely on approaches to the extensor muscle origins from the lateral humeral epicondyle. We hypothesize that these operations obtain their success due to stripping of the innervation from this joint. It has been demonstrated that the symptoms of failed tennis elbow surgery may be due to radial tunnel syndrome or a neuroma of the posterior cutaneous nerve of the forearm; neural etiologies. In order to investigate whether lateral humeral epicondylitis may be due to repetitive small stretch traction injuries in the innervation of the lateral humeral epicondyle, a series of 3 patients who failed conservative treatment (physical therapy, splinting and up to 6 cortisone injections) for tennis elbow, were treated with a denervation technique. They had classic physical examination for tennis elbow. One of the three patients had an associated radial tunnel syndrome. None had previous surgery to the elbow region. Branches of the posterior cutaneous nerve of the forearm and of the radial nerve branches to the brachioradialis that innervate the lateral humeral epicondyle were divided in each of these three patients. Intra-operative electrical stimulation identified the branch through the brachioradialis that was a non-motor branch. Two of the three patients had this branch. This operative approach was based on 10 fresh frozen dissections which confirmed the above innervation of lateral epicondyle. At 4 months following the surgery, each of the three patients was back at work and was free of their tennis elbow pain. The surgical approach used will be demonstrated and the cases with follow up results will be presented.