CHRONIC LATERAL ELBOW PAINARTHROSCOPIC EVALUATION AND ANALYSIS OF 397 PATIENTS

Abstract

The aim of this study was to document the findings and the pathology of tennis elbow during arthroscopy in patients who had failed conservative treatment for lateral elbow pain with a presumptive diagnosis of lateral epicondylitis (tennis elbow).

Materials and Methods: We carried out a prospective study of a consecutive series of 397 patients who underwent elbow arthroscopy for lateral elbow pain previously diagnosed as lateral epicondylitis. All the patients had a period of atleast six months of various conservative treatment modalitiesin the nature of NSAIDS, bracing physiotherapy and ultrasound. The arthroscopy procedures were performed by one of two surgeons using identical standard techniques and the findings were carefully documented.

Results: There were 238 men and 159 women in the study group: mean age 51 years (range 21 to 80 years). Synovitis was present in 173(44%), degenerative changes in 232 (58%), common extensor origin inflammation in 173(44%), radial head plica in 121(30%), loose bodies in 85(21%), ostephyte formation in 45(11%) and intra-articular adhesions in 26(6%).

Of the 232 patients who had degenerative changes 186(80%) had articular cartilage changes in the lateral compartment(radial head & capitellum), partial thickness loss in n=94(51%) and full thickness cartilage loss in n=92(49%).

Conclusion: The clinical diagnosis of lateral epicondylitis is applied to patients who have a variety of pathologies involving the tissues of the lateral compartment of the elbow. In addition to inflammation and degenerative tears of common extensor origin other pathologies such as synovitis, radial head plica, loose bodies and degenerative osteoarthritis should be considered.

This diagnosis of tennis elbow is often applied to patients with degenerative changes(osteoarthritis) involving the lateral compartment.

Advanced degenerative changes involving the articular cartilage of the lateral compartment can be present in patients with little or no abnormality visible on x-ray.

We conclude that arthroscopy is a definitive diagnostic tool to evaluate the various pathologies giving rise to lateral elbow pain and also helps in planning and initiating the appropriate treatment plan directed against specific and accurate conditions causing lateral elbow pain(lateral epicondylitis)