Hand-Grip Strength and Return to Heavy Manual Work at a Mean 5-Year Follow-up After Arthroscopic Release of Recalcitrant Lateral Epicondylitis

Fahmy Samir Fahmy, Mohamed ElAttar, Hossam Fathi Salem, Fahmy Samir Fahmy, Mohamed ElAttar, Hossam Fathi Salem

Abstract

Background: Lateral epicondylitis of the elbow is a common degenerative disorder in middle-aged patients. Surgery is reserved for patients who do not respond to nonoperative treatment.

Purpose: To evaluate hand-grip strength and return to heavy manual activities in patients engaged in work requiring heavy lifting after arthroscopic release of refractory lateral epicondylitis.

Study design: Case series; Level of evidence, 4.

Methods: The study included consecutive patients who underwent arthroscopic release of the extensor carpi radialis brevis tendon to treat recalcitrant lateral epicondylitis of the elbow, with a minimum 48-month follow-up. Functional outcome measures included assessment of hand-grip strength, visual analog scale for pain, and Mayo elbow performance score. The recorded measurements were compared at postoperative 1 and 6 months and the final assessment. Pre- and postoperative data were compared using the paired t test, and the various postoperative assessments were compared using 1-way analysis of variance.

Results: A total of 22 patients (mean ± SD; age, 34.6 ± 5.9 years) with a mean follow-up of 60.5 ± 4.7 months were included in our study. There were highly significant improvements between preoperative and 1-month postoperative results regarding hand-grip strength (17.5 ± 4.1 kg to 34.4 ± 6.8 kg), visual analog scale score for pain (7.86 ± 1.2 to 1.8 ± 1.09), and Mayo score (57.1 ± 7.9 to 89.3 ± 4.9; P < .00001 for all). Significant improvements were found on all 3 functional measures between 1 and 6 months postoperatively (P ≤ .05 was statistically significant), and there were nonsignificant improvements on all measures from 6-month to final follow-up. The patients regained 96.4% of their hand strength as compared with the unaffected side and returned to their previous activities without reporting serious complications.

Conclusion: Minimally invasive arthroscopic release of recalcitrant lateral epicondylitis of the elbow provided a satisfactory functional result, as shown by regaining of hand-grip strength in patients engaged in heavy manual occupations without significant morbidities.

Keywords: arthroscopic release; hand grip; recalcitrant; tennis elbow.

Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Magnetic resonance imaging T2 sequence. Coronal view shows increased signal intensity at the extensor carpi radialis brevis origin (white arrow) denoting tendon degeneration.
Figure 2.
Figure 2.
Handheld dynamometer used to measure the hand-grip strength.
Figure 3.
Figure 3.
Patient position and skin marking of anatomic landmarks of the elbow. AL, anterolateral portal; AM, anteromedial portal; O, olecranon; RH, radial head; UN, ulnar nerve.
Figure 4.
Figure 4.
Arthroscopic view showing hypertrophy of the radiocapitellar capsular complex with degeneration of the capsule and extensor carpi radialis brevis tendon. C, capitellum; RCC, radiocapitellar capsular complex; RH, radial head.
Figure 5.
Figure 5.
(A) The degenerated extensor carpi radialis brevis tendon before resection. (B) Debridement of the degenerated tendon and capsule using a 3.5-mm motorized shaver. C, capitellum; D, degenerated tendon.
Figure 6.
Figure 6.
After completion of the procedure, the extensor carpi radialis brevis tendon is completely released but not beyond the radial head equator with debulking of the radiocapitellar capsular complex. ECRL, extensor carpi radialis longus; RH, radial head.
Figure 7.
Figure 7.
Histogram for the results of hand-grip strength, VAS pain, and Mayo elbow performance score. VAS, visual analog scale.

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