Muhammad A. Quolquela
Background: Release of the extensor origin at the lateral epicondyle is fraught with complications, such as persistent pain due to adhesions at the surgery site, together with weakness of wrist extension due to lengthening of the extensor carpi radialis brevis muscle. Denervation of the lateral epicondyle through the division of the posterior cutaneous nerve of the forearm (PCNF) was proposed to alleviate pain without the drawbacks of release. Methods: It is a randomized controlled study of 42 patients with resistant tennis elbow divided into 2 groups. The first group included 19 patients treated by dividing the PCNF, and the second group included 23 patients treated by release of the extensor origin. Clinical diagnosis was proved on positive resisted wrist extension and forearm pronation tests. Under general anesthesia, the division of both branches of PCNF in the denervation group and the release of the ECRB tendinous origin in the release group. Results: In the denervation group, 17 patients (92%) reported no pain compared with 15 patients (67%) in the release group. Denervation group patients had an extension lag of 7 degrees compared with 13 degrees for the release group ( P =0.08). In the denervation group, hand grip strength had an average of 72 lb (91%) compared with 63 lb (77%) in the release group ( P =0.04). Denervation group patients had an average MEPS score of 95 points compared with 87 for the release group ( P =0.37). Conclusions: Denervation through division of branches of the posterior cutaneous nerve of the forearm for the management of tennis elbow is a simple, safe procedure with apparently better outcomes compared with common extensor release. Level of Evidence: Level IV.