Nirschl Surgical Technique for Concomitant Lateral and Medial Elbow Tendinosis

Abstract

Background: Combined lateral elbow tendinosis (tennis elbow) and medial elbow tendinosis (golfer’s elbow) can be a disabling condition that, if unresponsive to nonoperative treatments, may be effectively treated surgically. The authors are not aware of any study that reports the outcome of a combined operation for lateral and medial elbow tendinosis (country club elbow) performed in the same operative setting.

Hypothesis: Combined surgical treatment of country club elbow in the same operative setting has similar outcomes to those seen in the literature for single operative procedures.

Study Design: Case series; Level of evidence 4.

Methods: Outcome measurements included the Numeric Pain Intensity Scale, the Nirschl tennis elbow scoring system, and the American Shoulder and Elbow Surgeons elbow form. Forty-eight patients (53 clinical elbows) were available by telephone, with a minimum time to follow-up of 5 years (range, 5-19 years; mean, 11.7 years).

Results: The average Nirschl tennis elbow score improved from 16.7 preoperatively to 70.8 postoperatively (P < .01). The average American Shoulder and Elbow Surgeons elbow score improved from 45.2 to 90.4 (P < .01). The Numeric Pain Intensity Scale score improved from 8.8 to 1.7 (P < .01). By the criteria of the Nirschl tennis elbow score, results were rated excellent in 38 elbows, good in 7 elbows, fair in 5 elbows, and poor in 3 elbows, with 85% (45 of 53) good to excellent results. Patient satisfaction with the surgery averaged 8.7 out of 10. Of the 46 patients who played sports, 44 (96%) reported returning to their sports.

Conclusion: When nonoperative treatment of lateral and medial elbow tendinosis fails, combined surgical intervention via the Nirschl operative techniques for country club elbow is highly effective, with results similar to those of single-sided intervention.