May 5, 2015
Arthroscopy for tennis elbow anybody?
As Americans we like choices. Some surgeons pursue impractical choices of treatment for patients. One of them is arthroscopic treatment of tennis elbow. Another is radiofrequency lesioning and yet another one for general purposes is platelet-rich plasma. Platelet-rich plasma may well have a role, but the cost is prohibitive and so I reserve it for difficult resisting cases. It is yet unproven to be of any additional benefit over percutaneous elbow tenotomy but adds quite a bit of cost. Radiofrequency lesioning would just add a lot of extra costs without any added benefit due to the use of expensive equipment.
Arthroscopic resection of the extensor carpi radialis brevis was introduced over 15 years ago by surgeons aggressively using an arthroscope to treat many problems in the upper and lower extremities. There is what is called a “steep learning curve” with elbow arthroscopy to begin with; it puts all three nerves at the elbow at risk. It is a very expensive procedure because of the equipment that is necessary to use in the operating room under a general anesthetic and there is no added benefit. In fact, about close to 40% of the people who undergo arthroscopic removal of decayed tissue of the extensor carpi radialis brevis in the elbow continue to hurt, a substantial number of them being frank, outright failures. This was pointed out by Mark Cohen, MD, of Rush Hospital in Chicago in a webinar recently. He mentioned the results of four published studies (see references) and then the results of his own 30 cases and a third of his own cases continued to have pain. Most recently Yoon, et al., in Arthroscopy, July 2015, reported only 82% of patients thus treated were “satisfied” and 18% were frankly “dissatisfied”. In summary, I think that arthroscopic treatment of tennis elbow is an expensive, poor option for trying to deal with a problem that can be dealt with by percutaneous elbow tenotomy as indicated in our tennis elbow section of this website.