Purpose of the study: Epicondylalgia is a frequent condition although the cause and appropriate treatment remain a subject of debate. We present our experience with surgical treatment based on the hypothesis that the condition results from excessive tension on the deep aponeurosis of the carpal and digital extensors.
Material and methods: Between 1996 and 1998, sixteen patients underwent surgical treatment of epicondylalgia unresponsive to medical treatment. There were six men and ten women, men age 43 years, two underwent bilateral procedures. The dominant side was involved in 75% of the cases. For ten patients, heavy manual work led to epicondylalgia. For two others it was related to sports activities. Mean duration of medical treatment prior to surgery was 16 months. A double deep transverse fasciotomy of the extensor carpi radialis brevis (ECRB) was performed in all cases, alone for 3, and associated with section of the Fröhse arcade in 5, supinator fasciotomy in 9, and complete section of the superficial head of the supinator in 4. For five recent cases, double fasciotomy of the extensor digitorum communis (EDC) was also performed. The epicondyle was left intact as were all tendons. All patients were reviewed at a mean 20 months. The Roles and Maudsley classification was recorded. Motor force was measured comparatively with a Jamar dynometer.
Results: Outcome was excellent in 7 cases, good in 7 and acceptable in 4. All patients improved. Outcome was excellent in 2 cases and fair in 3 cases with double fasciotomy of the EDC. The period of work loss was 3 months on the average. Forty-six percent of the patients resumed their former activity at 6 weeks. Muscle force was globally reduced 21.5% compared with the contralateral side (range 0-60%).
Discussion: This surgical technique is based on the hypothesis that epicondylalgia results from excessive tension on the epicondylar area leading to enthesitis or aponeuritis, or both. Deep fasciotomy allowed distension and clinical improvement in all cases. Associated deep fasciotomy of the EDC in addition to the transverse fasciotomy of the ECRB and supinator appears to improve functional outcome.