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Cited by 176Elbow and Forearm Trauma TreatmentTendon Structure and TreatmentOrthopedic Surgery and Rehabilitation

Surgery for lateral elbow pain

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Buchbinder, Rachelle, Johnston, Renea V, Barnsley, Les, Assendelft, Willem JJ, Bell, Simon N, Smidt, Nynke·2011·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd003525.pub2PMC PMC7154580
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Abstract

BACKGROUND: Surgery is sometimes recommended for persistent lateral elbow pain where other less invasive interventions have failed. OBJECTIVES: To determine the benefits and safety of surgery for lateral elbow pain. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science unrestricted by date or language (to 15 December 2010). SELECTION CRITERIA: Randomised and controlled clinical trials assessing a surgical intervention compared with no treatment or another intervention including an alternate surgical intervention, in adults with lateral elbow pain. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion, assessed risk of bias and extracted data. MAIN RESULTS: We included five trials involving 191 participants with persistent symptoms of at least five months duration and failed conservative treatment. Three trials compared two different surgical procedures and two trials compared surgery to a non-surgical treatment. All trials were highly susceptible to bias. Meta-analysis was precluded due to differing comparator groups and outcome measures. One trial (24 participants) reported no difference between open extensor carpi radialis brevis (ECRB) surgery and radiofrequency microtenotomy, although reanalysis found that pain was significantly lower in the latter group at three weeks (MD -2.80 points on 10 point scale, 95% CI -5.07 to -0.53). One trial (26 participants) reported no difference between open ECRB surgery and decompression of the posterior interosseous nerve in terms of the number of participants with improvement in pain pain on activity, or tenderness on palpation after an average of 31 months following surgery. One trial (45 participants) found that compared with open release of the ERCB muscle, percutaneous release resulted in slightly better function. One trial (40 participants) found comparable results between open surgical release of the ECRB and botulinum toxin injection at two years, although we could not extract any data for this review. One trial (56 participants) found that extracorporeal shock wave therapy (ESWT) improved pain at night compared with percutaneous tenotomy at 12 months (MD 5 points on 100 point VAS, 95% CI 1.12 to 8.88), but there were no differences in pain at rest or pain on applying pressure. AUTHORS' CONCLUSIONS: Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain. Further well-designed randomised controlled trials and development of standard outcome measures are needed.

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  • The general consensus has been to prioritize conservative interventions and restrict surgery to the small proportion of patients who have failed conservative care.

    “Despite a lack of strong evidence regarding optimal management, the general consensus has been to prioritize conservative interventions [18,19] and restrict surgery to the small proportion of patients who have failed conservative care [3,4,19,20].”

    From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [20]

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Cited by

Sorted by citations

Authors
Buchbinder, R., Johnston, R. V., Barnsley, L., Assendelft, W. J., Bell, S. N., & Smidt, N.
Affiliations
  • Cabrini Hospital (AU)
  • Concord Hospital (US)
  • Leiden University Medical Center (NL)
  • Monash Medical Centre (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2011-03-16
Issue
3
Pages
CD003525-CD003525
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd003525.pub2
PMC
PMC7154580
OpenAlex
W2117214618
Cited by
176
References
3
Citations by year
2026: 3 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 8 · 2021: 15 · 2020: 4 · 2019: 11 · 2018: 10 · 2017: 10 · 2016: 10 · 2015: 8 · 2014: 8 · 2013: 15 · 2012: 6
FWCI
1.41
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
U.S. Department of Health and Human Services
Topics
  • Health Sciences › Medicine › Rehabilitation › Elbow and Forearm Trauma Treatment
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
  • Health Sciences › Medicine › Surgery › Orthopedic Surgery and Rehabilitation
Keywords
lateral elbow pain, elbow surgery, extensor carpi radialis brevis, percutaneous tenotomy, botulinum toxin injection, extracorporeal shock wave therapy, surgical versus non-surgical treatment, treatment safety, pain outcomes, elbow function, risk of bias in trials, trial heterogeneity
MeSH terms
Adult, Humans, Tennis Elbow, Randomized Controlled Trials as Topic, Catheter Ablation, Tenotomy

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