Abstract
We examined the extent and effect of an assumed neuromuscular transmission disorder by performing a prospective clinical study on 75 patients with therapy-resistant radiohumeral epicondylopathy. Before operating, we diagnosed with electromyography an increased rate of polyphasic potentials of the long wrist extensors as well as a prolonged motor latency of the respective muscles. Disordered neuromuscular recruitment combined with a reduced maximum strength and elasticity corresponding to the suspected damage to the distal part of the motor neuron could be proven. Both effects were significantly reversible (P < 0.001) through operative intervention. We found a significant correlation (> 0.90) between the normalization of the motor latency and increased strength. Subgroups were formed according to different preoperative diagnostic efforts and differing radicality regarding the type of soft-tissue operation performed; thus, the clinical validity of the findings diagnosed in the anatomical/electrophysiological part of the study was additionally examined. The failure rate varied between 10% and 30%, depending on the radicality of the tenotomy, which could be interpreted as a general indication for a complete extensor carpi radialis brevis tendon release. In this connection it is remarkable that the clinical result of electromyographically localized damage in the area between the epicondyle and arcade of Frohse could not be improved through open neurolysis. Dealing with strictures located on the proximal side of the epicondyle on the other hand, this technique seems to play an important role in the recurrence prophylaxis.
Similar content being viewed by others
References
Aeckerle J, Heisel J, Mittelmeier H (1984) Spätergebnisse der operativen Behandlung der Epikondylitis humeri mit dem Radikaloperationsverfahren nach Mittelmeier. Orthop Praxis 3:207–217
Arcq M, Pfeiffer I (1992) Die operative Behandlung der Epikondylopathie durch Fascia lata Plastik. Orthop Praxis 12:841–843
Burton AM (1988) Grip strength and forearm straps in tennis elbow. Br J Sports Med 19:37–38
Cybex-II (1989) Users' manual. Leuenberger Medizin Technik, Glattburch, pp 6–63
Garden RS (1961) Tennis elbow. J Bone Joint Surg [Br] 43:100–106
Giattini JF (1968) The anatomy of the radial nerve at the elbow and its relationship to tennis elbow. J Bone Joint Surg [Am] 50:843–846
ohmann G (1933) Das Wesen und die Behandlung des sogenannten Tennisellbogens. Münch Med Wochenschr 80:250–252
Inoue SI, Watanabe T, Hirose A, Tanaka T, Matsuii N, Saegusa O, Sho E (1984) Anterior discectomy and interbody fusion for lumbar disc herniation. Clin Orthop 183:22–31
Kaplan B (1959) Treatment of tennis elbow by denervation. J Bone Joint Surg [Am] 41:147–151
Kuhr M, Arnold H (1992) Langzeitergebrtisse nach Diszision nach H. Hohmann und ihre Wertigkeit fur die Atiopathogenese der Epikondylopathie des Ellenbogens. Orthop Praxis 12:837–840
Lanz T v, Wachsmuth W (1959) Praktische Anatomic I, Part 3, 2nd ed. Springer, Berlin Heidelberg New York, pp 117–175
Lundberg A, Malmgren K, Schomburg ED (1987) Reflex pathways from group II muscle afferents. Secondary spindle afferents from the FRA: a new hypothesis. Exp Brain Res 65:294–306
Maier P, Scharf HP, Noack W (1988) Möglichkeiten und Grenzen bei der Interpretation unterschiedlicher Krankheitsbilder und Trainingszustände mit isokinetischen Systemen. In: Puhl W, Noack W, Scharf HP, Sedunko F (eds) Isokinetisches Muskeltraining in Sport and Rehabilitation. Perimed, Erlangen, pp 40–48
Nirschel RP (1985) Sports and overuse injuries to the elbow. (Muscle and tendon trauma 28) B. F. Murrey Saunders, Philadelphia, pp 481–496
Oerke HP, Horst M, Jacobson K, Anders G, Bruns H, Dustmann HO, Haas HH, Heers H, Kamali D, Krause W, Laumann U, Nitsch R, Pachowsky H, Thomas W, Wirth D, Zenker H (1976) Gemeinschaftsstudie Epikondylitis humeri. Orthop Praxis 4:265–269
Paar O, Zweymüller K, Sauer G (1978) Zur Operationstechnik der Epikondylitis humeri radialis. Vergleich der einfachen Hohmann'schen Einkerbung mit der Denervierung nach Wilhelm. Chirurgie 49:520–522
Rohen JW (1984) Funktionelle Anatomie des Menschen. Schattauer, Stuttgart, pp 85–108
Roles NC, Maudsley RH (1972) Radial tunnel syndrome. J Bone Joint Surg [Br] 54:499–508
Rossum J, Buruma OJ (1978) Tennis elbow — a radial tunnel syndrome? J Bone Joint Surg [Br] 60:197–198
Rudolph M, Hochheim B (1992) Erfahrungen mit der operativen Behandlung der Epikondylitis humeri radialis. Orthop Praxis 12:844–845
Spinner M (1968) The arcade of Frohse and its relationship to posterior interosseous nerve paralysis. J Bone Joint Surg [Br] 50:809–812
Stratford PW, Norman GR, McIntosh JM (1989) Generalizability of grip strength measurements in patients with tennis elbow. Phys Therapy 69:276–281
Strohmeyer A, Boumann E (1983) Rezidivursache der Epikonylitis und ihre Folgerungen. Orthop Praxis 4:284–286
homas W, Tillmann B (1980) Engpaßsyndrome des N. Radialis im Ellenbogenbereich im Rahmen der Epikondylitis humeri radialis — Klinisch Anatomische Untersuchungen. Z Orthop 118:41–46
Vichave NA (1969) Spontaneous paralysis of the anterior interosseus nerve. J Bone Joint Surg [Br] 50:806–808
Wanievenhaus A (1991) Die Rezidiv Epikondylitis nach Wilhelm'scher Operation und ihre Therapie. Wiener Klin Wochenschr 103:626–628
Weh L, Meyer-Ralfs H (1989) Epikondylopathie und Mobilität der Halswirbelsäule. Orthop Praxis 3:126–130
Weihrauch C, Skorpik G, Landsiedl F (1992) Epikondylopathia humeri radialis — Eine Vergleichsstudie der einfachen Operation nach Hohmann mit der erweiterten Operation nach Hohmann. Orthop Praxis 12:846–848
Wemer CO (1979) Lateral elbow pain and posterior interosseus nerve entrapment. Acta Orthop Scand Suppl 174:1–62
Wilhelm A (1979) Das Radialisirritationssyndrom (Epikondylitis humeri radialis, Syloiditis radii, Neuralgic des N. interosseus dorsalis). Handchirurgie 2:139–142
Wilhelm A (1978) Radialiskompressionssyndrome. Handchirurgie 8:113–116
Wilhelm A (1989) Therapieresistente Epikondylitis humeri radialis und Denervationsoperation. Oper Orthop Traumatol 1:25–34
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Albrecht, S., Kleihues, H., Cordis, R. et al. Diagnostic and therapeutic strategies for the operative treatment of radiohumeral epicondylopathy. Arch Orthop Trauma Surg 116, 164–172 (1997). https://doi.org/10.1007/BF00426066
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00426066