No Difference Between Surgery and Placebo Surgery For Tennis Elbow
Tennis elbow or lateral epicondylalgia is a painful condition affecting the wrist and finger extensor tendons as they attach into the arm. Breakdown of the tendon at its' insertion and weakness in the forearm muscles lead to pain and reduced tolerance for gripping and hand movements. Physical Therapy treatments including manual therapy to the spine and extremity joints has been shown to accelerate recovery and lead to reduced healthcare utilization over the long term. Importantly, manual therapy improves a patient's tolerance for strength training exercises which allow for long term relief. Patient's who do not improve with conservative treatments may opt for surgical debridement of the injured tendon and muscle.
A recent double blinded, randomized controlled trial compared the effectiveness of surgery to a sham or placebo surgery in patients with chronic tennis elbow pain (Krosiak et al. Am J Sports Med. 2018). Patients were randomized to either a sham/placebo group (skin excision and exposure of the tendon) or a surgical debridement and excision of the affected tissue. Interestingly, both groups improved pain and function at 6 month follow up but there were no significant differences between groups. Authors stopped the study early due to the lack of differences between the surgical and placebo groups. The authors reported no additional benefit of surgery over placebo for patients with chronic elbow pain.