الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Arthroscopy nowadays increasingly used to diagnose and treat elbow pathology, even though the elbow has always been considered a difficult joint to be arthroscopically explored. An increase in arthroscopy knowledge and skills, as well as technological advances in the last years has allowed a standardization of techniques and a better definition of indications. The aim of the current study was to compare between release of ECRB with and without decortication in management of resistant tennis elbow cases regarding results and clinical outcome, and safety and possible complications of its use.
The present study included 20 patients with resistant tennis elbow problems. This study was carried out in the period between June 2018 and June 2019 at Sohag University Hospital.
All the patients involved in the study were subjected to: meticulous clinical evaluation, investigations, radiological assessment and scoring. The Disabilities of the Arm, Shoulder and Hand (DASH) Score, Nirschl staging system and Visual Analogue Scale (VAS) were used preoperative, immediate postoperative, two weeks, four weeks, ten weeks and six months postoperatively for assessment of patients.
Half of the patients underwent arthroscopic release of ECRB only while the other half of patients underwent release of ERCB with decortication of the lateral epicondyle.
Summary & conclusion
In our study group, which included 9 males and 11 females with mean age of 39.3 years , the mean DASH score improved from 24.8 points preoperative to 6.75 points at six months postoperative. The mean Nirschl staging improved from 4.45 points preoperative to 1.75 points at six months postoperative . Concerning the pain, the mean VAS improved from
points preoperative to 2 points at six months follow up postoperative. with overall satisfaction 16 and 4 not satisfied patients. All improvements in the previous scores were statistically significant . Only three patients suffered complications in the form of 2 ular nerve injury which recovered and 1 septic elbow which resolved with medical treatment. There were no clinical or statistically significant difference in results between the group that underwent release of ERCB only and the group that underwent release of ERCB with decortications of lateral condyle.
Summary & conclusion
Conclusions
Role of elbow arthroscopy has expanded dramatically and is becoming a much more common procedure. It has a vital role for diagnosing and treating many elbow disorders. Removal of loose bodies, osteophytes, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for elbow arthroscopic surgeons.
Arthroscopic surgeons should follow stepwise advancement with experience and vast knowledge of arthroscopic anatomy and anatomy related to the portals to perform a successful surgery. The complex anatomy in a relatively small space, proximity of the major nerves and vessels, and lack of surgeon familiarity all contribute to the steep learning curve of elbow arthroscopic surgery.
Clinical outcomes of an arthroscopic release of the ECRB tendon showed to be safe and effective for chronic lateral epicondylitis resistant to conservative measures. Arthroscopic release of the ECRB tendon for lateral epicondylitis is a minimally invasive and reproducible procedure with marked postoperative increase in function within a short rehabilitation period. Arthroscopic release beside it effectively treats lateral epicondylitis, it also affords visualization of the joint space to address associated intraarticular pathology.
Pain relief and early restoration of elbow function can be reliably achieved with minimal morbidity and high rate of patient satisfaction after arthroscopic release of ECRB for lateral epicondylitis. Minor complications of elbow arthroscopy include transient nerve palsies as the
Summary & conclusion most common occurrence, followed by superficial wound infection. In this study, there were two transient ulnar nerve palsies and one septic elbow .
Major complications include permanent nerve injury and tourniquet related complications. In the current study, there was one patient with permanent nerve palsy. Most elbow arthroscopy complications can be avoided with careful patient selection, proper surgical indications, thorough understanding of the anatomy, and experience.
There was no significant difference in the function between the arthroscopic simple ECRB release and the decortication group. In the simple ECRB release group, minimal postoperative pain, early rehabilitation, and early return to activity could be achieved. Arthroscopic ECRB release with decortication is a treatment option for lateral epicondylitis, but the findings of our study suggest that adding decortication can be associated with significant morbidity in the early postoperative period and may not be beneficial in treating lateral epicondylitis.