DIAGNOSTIC AND THERAPEUTIC STRATEGIES FOR THE OPERATIVE TREATMENT OF RADIOHUMERAL EPICONDYLOPATHY

We examined the extent and effect of an assumed neuromuscular transmis sion disorder by performing a prospective clinical study on 75 patient s with therapy-resistant radiohumeral epicondylopathy. Before operatin g, we diagnosed with electromyography an increased rate of polyphasic potentials of the long wrist extensors as well as a prolonged motor la tency of the respective muscles. Disordered neuromuscular recruitment combined with a reduced maximum strength and elasticity corresponding to the suspected damage to the distal part of the motor neuron could b e proven. Both effects were significantly reversible (P < 0.001) throu gh operative intervention. We found a significant correlation (> 0.90) between the normalization of the motor latency and increased strength . Subgroups were formed according to different preoperative diagnostic efforts and differing radicality regarding the type of soft-tissue op eration performed; thus, the clinical validity of the findings diagnos ed in the anatomical/electrophysiological part of the study was additi onally examined. The failure rate varied between 10% and 30%, dependin g on the radicality of the tenotomy, which could be interpreted as a g eneral indication for a complete extensor carpi radialis brevis tendon release. In this connection it is remarkable that the clinical result of electromyographically localized damage in the area between the epi condyle and arcade of Frohse could not be improved through open neurol ysis. Dealing with strictures located on the proximal side of the epic ondyle on the other hand, this technique seems to play an important ro le in the recurrence prophylaxis.