Surgery for lateral elbow pain

R Buchbinder, S Green, S Bell, L Barnsley, N Smidt, W J Assendelft
Cochrane Database of Systematic Reviews 2002, (1): CD003525

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the lateral elbow and forearm and lack of strength and function of the elbow and wrist. Surgery is sometimes recommended in treating chronic cases of lateral elbow pain where other less invasive interventions have failed. Various operations have been described based upon the surgeon's concept of the pathological entity. The most described surgical procedures involve release of the extensor carpi radialis brevis (ECRB) from the lateral epicondyle region based upon the premise that there is pathology in the attachment of ECRB to the lateral epicondyle. No systematic review has previously been published assessing the effect of surgical interventions for lateral elbow pain.

OBJECTIVES: To determine the effectiveness of surgical interventions in the treatment of adults with lateral elbow pain.

SEARCH STRATEGY: Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trials Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were researched in an effort to identify as many trials as possible. Searches were conducted up to October 2001.

SELECTION CRITERIA: Two independent reviewers assessed all identified studies against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were to be included in the review provided they were studying the effects of a surgical intervention and included a control as treatment for adults with lateral elbow pain. The control intervention could comprise no treatment or another intervention including an alternate surgical intervention. Outcomes of interest included pain, function, disability and quality of life, strength and adverse effects.

DATA COLLECTION AND ANALYSIS: The planned collection and analysis of data is described.

MAIN RESULTS: Our search did not identify any controlled trials investigating the effect of surgery on lateral elbow pain.

REVIEWER'S CONCLUSIONS: At this time there are no published controlled trials of surgery for lateral elbow pain. Without a control group, it is not possible to draw any conclusions about the value of this modality of treatment.

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