title: Clinical and ultrasonographic results of ultrasonographically guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis.
abstract: BACKGROUND
  In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques.
  
  
  OBJECTIVE
  The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis.
  
  
  METHODS
  
  
  
  METHODS
  Level of evidence, 4.
  
  
  METHODS
  Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications.
  
  
  RESULTS
  At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition (P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly (P < .01). The MMCPI score improved from "poor" to "excellent." The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient.
  
  
  CONCLUSIONS
  Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.
authors.affiliation: Department of Orthopaedics, National Cheng Kung University Hospital, No. 138 Sheng-Li Road, Tainan City, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Jung-Shun
authors.initials: JS
authors.lastname: Lee
authors.forename: Wei-Ren
authors.initials: WR
authors.lastname: Su
authors.forename: Li-Chieh
authors.initials: LC
authors.lastname: Kuo
authors.forename: Ta-Wei
authors.initials: TW
authors.lastname: Tai
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Jou
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods*; D004550:Elbow / Q000000981:diagnostic imaging / Q000601:surgery; D005080:Exercise Test; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain / Q000503:physiopathology; D010147:Pain Measurement; D017060:Patient Satisfaction; D010865:Pilot Projects; D013716:Tennis Elbow / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal