title: Factors associated with failure of nonoperative treatment in lateral epicondylitis.
abstract: BACKGROUND
  Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail.
  
  
  OBJECTIVE
  To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment.
  
  
  METHODS
  Case control study; Level of evidence, 3.
  
  
  METHODS
  A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment.
  
  
  RESULTS
  Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from their initial visit. Univariate analysis demonstrated a potential association (P < .10) between operative management and the following factors at initial diagnosis: increased age, body mass index, duration of symptoms, presence of radial tunnel syndrome, prior injection, physical therapy, splinting, smoking, workers' compensation, a labor occupation, use of narcotics, use of antidepressant medications, and previous orthopaedic surgery. In the final multivariable model, a workers' compensation claim (odds ratio [OR], 8.1), prior injection (OR, 5.6), the presence of radial tunnel syndrome (OR, 3.1), previous orthopaedic surgery (OR, 3.2), and duration of symptoms >12 months (OR, 2.5) remained significant independent predictors of surgical treatment.
  
  
  CONCLUSIONS
  This study identifies risk factors for surgical treatment for lateral epicondylitis. While these findings do not provide information regarding causal factors associated with surgery, these patient and disease-specific considerations may be helpful when counseling patients regarding treatment options and the likelihood of the success of continued nonoperative treatment.
authors.affiliation: Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA.
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Knutsen
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Goldfarb
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA Institute of Clinical and Translational Sciences, Washington University School of Medicine, St Louis, Missouri, USA oseid@wustl.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Osei
mesh_terms: D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D019233:Retreatment / Q000706:statistics & numerical data; D013716:Tennis Elbow / Q000628:therapy*; D017211:Treatment Failure; D014942:Workers' Compensation / Q000706:statistics & numerical data
keywords: elbow; epicondylitis; lateral; tennis; treatment