Impact d’une neurolyse systématique du nerf radial lors d’une cure chirurgicale d’épicondylite. Étude prospective, randomisée, simple aveugle

Abstract

When considering surgical intervention for elbow and forearm pain, the diagnosis of Radial Tunnel syndrome is often dismissed or overlooked. Ultrasonography provides clear evidence of lateral epicondylitis, however, paraclinical tests such as electromyography are prone to false negative results, and are therefore unreliable in determining whether compression of the radial nerve may be a contributing factor to persistent pain. Our study examines the impact of systematically combining the surgical procedures to release compression of the posterior interosseous nerve, concurrently with repairs for lateral epicondylitis, to address both conditions at once. The objective is to recommend a more thorough surgical protocol to improve effective pain resolution and efficiently reduce reintervention. We conducted a prospective randomized single-blind monocentric clinical trial in 54 patients suffering from lateral epicondylitis confirmed by ultrasonography, without any electromyographic or imaging sign of compression of the posterior interosseous nerve in Frohse's Arcade. All patients were previously unresponsive to well-followed conservative and non-invasive treatment. Patients were randomly selected and equally divided into intervention (supplemental radial nerve release) and control groups (no radial nerve release). Three surgeons performed exactly the same surgical techniques for the lateral epicondylitis (all patients) and the supplemental radial nerve release (intervention group only). Patient's clinical symptoms and activities in the daily living were assessed prior to surgery using both QuickDash and Mayo Elbow Performance Score (MEPS) and again at one-, three-, and six-month intervals after surgery. Significant positive outcomes were observed across both groups from the first month after surgery and for the whole evaluation period for both MEPS and QuickDash scores. Meaningful statistically significant better outcomes for the interventional group when using MEPS at 6 months post-surgery. At 6 months after surgery, good and excellent results were reported for 24 out of 26 patients for the interventional group (92 %) and for 19 out of 28 for the control group (65 %). The combined treatment allows a greater improvement in symptoms at 6 months after surgery with a tendency to improve the patient's daily living activities. Patients are generally more satisfied. A supplemental radial nerve release can be offered to patients undergoing surgery for lateral epicondylitis not responding to conservative treatment.