A Cochrane review [Abstract] 1 on surgery for lateral elbow pain included 5 trials involving 191 participants with persistent symptoms of at least five months duration and failed conservative treatment. All trials were highly susceptible to bias. One trial (n=24) reported no difference between open extensor carpi radialis brevis (ECRB) surgery and radiofrequency microtenotomy, although reanalysis found that pain was significantly lower in the latter group at 3 weeks (MD -2.80 points on 10 point scale, 95% CI -5.07 to -0.53). One trial (n=26) reported no difference between open ECRB surgery and decompression of the posterior interosseous nerve in terms of the number of participants with improvement in pain pain on activity, or tenderness on palpation after an average of 31 months following surgery. One trial (n=45) found that percutaneous release resulted in slightly better function compared with open release of the ERCB muscle. One trial (n=40) found comparable results between open surgical release of the ECRB and botulinum toxin injection at two years. One trial (n=56) found that extracorporeal shock wave therapy (ESWT) improved pain at night compared with percutaneous tenotomy at 12 months (MD 5 points on 100 point VAS, 95% CI 1.12 to 8.88), but there were no differences in pain at rest or pain on applying pressure.
Comment: The quality of evidence is downgraded by limitations in study quality, by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (limited study size for each comparison).
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