title: Fractional lengthening of forearm extensors for resistant lateral epicondylitis.
abstract: BACKGROUND
  This study presents the surgical technique of fractional lengthening of extensor carpi radialis brevis, extensor digitorum communis and the superficial head of supinator, for chronic lateral epicondylitis. The anatomical basis for this surgical approach is reviewed. The results of surgical treatment in a consecutive series of patients with severe chronic lateral epicondylitis are reviewed.
  
  
  METHODS
  Twenty-one elbows in 17 subjects underwent surgery. All elbows had severe resistant symptoms, unresponsive to a minimum 6 months (mean 14 months) of a non-operative treatment protocol. All elbows showed either tendonopathy or a partial tear in the common extensor tendon origin at preoperative imaging.
  
  
  RESULTS
  All subjects were examined at a minimum of 1 year after surgery. The mean visual analogue pain (VAS) score reduced from 7.6 (maximum 10) preoperatively to 1.3 postoperatively (P<0.01). The mean preoperative ability to carry out normal work duties reduced from 4.3 (maximum 5) preoperatively to 1.5 postoperatively (P<0.01). Grip strength improved or remained equivalent following surgery. The mean VAS for patient satisfaction with surgery was 8.8 (maximum score 10). Using the Roles and Maudsley classification, 14 patients (82%) were rated good or excellent. Three subjects were rated fair or poor, were undergoing treatment for other pathology in the ipsilateral extremity and had ongoing compensation claims.
  
  
  CONCLUSIONS
  Fractional lengthening of forearm extensors is effective treatment for severe and chronic lateral epicondylitis. Outcomes following fractional lengthening surgery are less predictable when other pathology in the upper extremity requires concomitant treatment.
authors.affiliation: Department of Orthopaedic Surgery, Queen Elizabeth Medical Centre, Perth, Western Australia, Australia. allanwang@aapt.net.au
authors.forename: Allan W
authors.initials: AW
authors.lastname: Wang
authors.forename: Sani
authors.initials: S
authors.lastname: Erak
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005542:Forearm / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013710:Tendons / Q000601:surgery*; D013716:Tennis Elbow / Q000601:surgery*; D016896:Treatment Outcome