Lateral Epicondylitis/Tendinosis

Introduction

The term tendinosis is preferred to epicondylitis as this is more descriptive of the true pathology. Epicondylitis (tendinosis) occurs at least five times more commonly on the lateral than on the medial aspect of the joint. The selection factors to determine the candidates for surgery are similar for each process, yet there are some distinct features with regard to the surgical technique. Thus, medial epicondylitis is discussed separately in Chapter 61 .

Indications/Contraindications

Pain is the major indication for surgery of lateral elbow tendinosis. There are three broad indications and a fourth feature to consider:

• 1

  Pain is of significant intensity as to limit function and interferes with daily activity or occupation (Nirschl pain phases 5, 6, or 7) ( Box 59.1 ).

  Box 59.1

  From Nirschl RP: Elbow tendinosis/tennis elbow, Clin Sports Med 11:851–870, 1992.

  Nirschl Pain Phase Scale

  Phase 1

  Stiffness or mild soreness after activity. Pain is usually gone within 24 hours.

  Phase 2

  Stiffness or mild soreness before activity that is relieved by warm-up. Symptoms are not present during activity but return afterward and last up to 48 hours.

  Phase 3

  Stiffness or mild soreness before specific sport or occupational activity. Pain is partially relieved by warm-up. It is minimally present during activity but does not cause the athlete to alter activity.

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