In case of a frustrated, conservative therapy attempt of an epicondylopathia humeri radialis of at least 6 months with persistent complaints, a surgical therapy alternative can be discussed in case of a structural-morphological and clinical correlate [S2k guideline].
Arthroscopic (via arthroscopy) and open procedures result in an average higher pain reduction (VAS/NRS) and better functional scores (DASH) than percutaneous procedures in chronic cases [S2k guideline].
Surgical Procedures
1st order for chronic course or rupture of the tendon:
- Hohmann surgery (Hohmann operation) – crescent-shaped release of the extensors (extensors), including the degenerative tissue from the epicondyle humeri radialis; the tendon is incised transversely (incised).
- Operation according to Wilhelm (Wilhelm operation) – denervation of nervous structures (complete or partial interruption of nerve pathways) at the epicondyle humeri radialis and release of the supinator muscle from the extensor carpi radialis brevis (ECRB); in the process, the painful area is denervated (Wilhelm operation is often combined with the Hohmann operation)
- Operation according to Goldie (Goldie operation) – the operation is similar to the Hohmann operation; in this case, the tendon is incised longitudinally
Possible complications
- Persistent (ongoing) discomfort
- Iatrogenic (physician-induced) injury to the lateral outer wall with subsequent instability
- Wound infection rate (lower in open procedures than in arthroscopic procedures).
