Surgical Failure

Tennis Elbow Secrets Revealed

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The surgical procedures to address tennis elbow are extremely reliable. Success rates of approximately 90% can be expected. Typically, the most common cause of perceived surgical failure is a return to activity that is too aggressive. In the absence of secondary gain issues (i.e., workers' compensation claims), pain from 6 to 9 months after surgery is unusual in a compliant patient.

Morrey differentiated surgical failures into two types: type I, patients whose symptom complex is similar to their preoperative state; and type II, patients whose symptom complex is different.30 The most common cause of type I failure is incomplete resection of all abnormal tis-sue.27,30 When identical symptoms persist, the initial diagnosis must be questioned. Other causes of pain at the lateral aspect of the elbow need to be considered. These include intra-articular pathologic conditions, posterior in-terosseous nerve entrapment at the arcade of Frohse, extensor compartment syndrome,4 and instability. Especially in workers' compensation patients, the issues of patient motivation, job satisfaction, and secondary gain all deserve attention.

Type II failures are usually iatrogenic. Ligamentous instability, synovial fistula, and adventitial bursa formation are the typical culprits. Synovial fistula formation is

FIGURE 6.12. A logical sequence of assessment for patients with surgical failure for lateral epicondylititis. Notice that the majority of categories indicates that no surgical intervention is necessary. Also note the major distinction between symptoms that are the same (type I) and those that are different (type II). (From Morrey BF.30)

FIGURE 6.12. A logical sequence of assessment for patients with surgical failure for lateral epicondylititis. Notice that the majority of categories indicates that no surgical intervention is necessary. Also note the major distinction between symptoms that are the same (type I) and those that are different (type II). (From Morrey BF.30)

associated with percutaneous techniques.18 Posterolateral instability results from incompetency of the ulnar band of the lateral collateral ligament. Medial instability usually is caused by dissection posterior to the accessory anterior oblique ligament, with subsequent disruption of the anterior oblique ligament.

Diagnostic injections can be very useful in the evaluation of failed tennis elbow surgery. Morrey presented a logical algorithm for the evaluation of failed procedures (Fig. 6.12).30 Injections can be used at the epicondyle or at the arcade of Frohse to differentiate posterior interos-seous nerve compression from persistent lateral epicondylitis. Fluoroscopy or arthrography can be used to evaluate potential instability. The arthrogram also demonstrates bursal or capsular defects. If a definitive diagnosis can be made with the use of the algorithm, surgical treatment can be recommended.

The results of surgical procedures for failed epi-condylitis surgery cannot be expected to approach the 90% reported with primary procedures. The surgeon must remember that these are salvage procedures. Organ et al. reported 83% good to excellent results in patients who underwent excision and repair after failed procedures.27 Morrey reported satisfactory results in 11 of 13 (85%) patients following secondary procedures in a select group of patients.30

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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