title: Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability.
abstract: OBJECTIVE
  In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy.
  
  
  METHODS
  We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction.
  
  
  RESULTS
  Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation.
  
  
  CONCLUSIONS
  Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate.
  
  
  METHODS
  Level III.
authors.affiliation: Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Kniesel
authors.forename: Jochen
authors.initials: J
authors.lastname: Huth
authors.forename: Gerhard
authors.initials: G
authors.lastname: Bauer
authors.forename: Frieder
authors.initials: F
authors.lastname: Mauch
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000601:surgery; D001168:Arthritis / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D003646:Debridement; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000601:surgery; D013716:Tennis Elbow / Q000150:complications / Q000601:surgery*