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

ABSTRACT

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. To investigate whether lateral humeral epicondylitis may be due to repetitive small stretch traction injuries in the innervation of the lateral humeral epicondyle, three patients who failed conservative treatment (physical therapy, splinting, and up to 6 cortisone injections) for tennis elbow, were treated with a denervation technique.

Patients underwent classic physical examination for tennis elbow. One of 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 radial nerve branches to the brachioradialis that innervate the lateral humeral epicondyle were divided in each patient. Intraoperative electrical stimulation identified the branch through the brachioradialis that was a nonmotor branch. Two of 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 postoperatively, each patient was back at work and free of tennis elbow pain.

The surgical approach used will be demonstrated and the cases with follow-up results will be presented.