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Factors Predictive of Failure of Non-operative Treatment in Lateral Epicondylitis
Elisa J. Knutsen, MD; Raymond Chen; Ryan Calfee, MD; Daniel Osei, MD
Washington University, St. Louis, MO

Introduction: Lateral epicondylitis often resolves after a course non-operative treatment. However, for a minority of patients, the symptoms persist beyond a year and are non-responsive to physical therapy, injections, medications or other non-surgical interventions. The primary aim of this study was to identify patient and disease factors that may predict the failure of non-operative treatment of lateral epicondylitis, defined as a progression to surgical treatment.
Materials & Methods:This case-control study analyzed 595 patients treated for lateral epicondylitis between 2007 and 2012 within our institution. Patient-specific and demographic characteristics were compared between patient groups (successful non-operative treatment vs surgery required) including sex, age, body mass index, handedness, smoking status, occupation, workers' compensation status, use of narcotic, anti-depressant or anti-anxiety medications, and the number of prior orthopaedic procedures. In addition, the following treatment-related variables were collected: duration of symptoms, history of an injection, a course of physical therapy, use of a splint, a concomitant diagnosis of radial tunnel syndrome and prior treatment by another physician. A forward entry multivariate logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of non-operative treatment.
Results: Of the 595 patients treated for lateral epicondylalgia, 101 (17%) failed non-operative treatment. Univariate analysis demonstrated a significant difference (p < .05) between the non-operative and operative groups for the following baseline characteristics: age, duration, radial tunnel syndrome, prior injection, smoking, occupation, workers' compensation, and use of anti-depressants. In our final multivariate model, the presence of radial tunnel syndrome (OR 3.1, 95% CI: 1.6, 6.3), workers' compensation claim (OR 5.7, 95% CI: 2.6, 12.6,), prior injection (OR 12.0, 95% CI: 5.1, 28.1,), use of anti-depressant medications (OR 2.1, 95% CI: 1.0. 4.3,) and duration of symptoms greater than 12 months (OR 1.5, 95% CI: 1.1, 1.9) remained significant independent predictors of failure of non-operative treatment.
Conclusions:
1. Patients being treated for lateral epicondylitis that present with radial tunnel syndrome, a workers' compensation claim, history of injection, use of anti-depressant medications or symptoms for greater than 12 months are more likely to fail conservative treatment for their lateral epicondylitis and may benefit from earlier surgical intervention.
2. Prospective studies are needed to confirm the roles of these baseline characteristics and to elucidate the role of symptom severity, which was not collected in our study.


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