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Lateral Epicondylitis: An Institutional Experience Treating 1498 Patients
Peggy J. Ebner, MD
1, Theodore M. Brown, BS
2, Meghan C. McCullough, MD, MS
2, Stuart Kuschner, MD
2; David A. Kulber, MD, FACS
3(1)USC Medical School, Los Angeles, CA, (2)Cedars-Sinai Medical Center, Los Angeles, CA, (3)Division of Plastic and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Lateral epicondylitis (LE) is common but can be difficult to treat, as many patients respond to conservative treatments but those who do not may require multiple visits, advanced imaging, and surgical reconstruction. This study examines treatment patterns of patients with LE by fellowship trained hand surgeons at a large academic medical center.
Materials & Methods: The electronic medical record was queried for patients with a diagnosis code for LE. Demographics, co-morbid conditions, insurance status, tobacco use, laterality, number of visits, number of corticosteroid injections, use of advanced imaging, use of platelet rich plasma (PRP) treatments, and surgical interventions were recorded. For patients who underwent invasive interventions (PRP and/or surgery) manual chart checks were performed to collect data regarding etiology, specific treatment, and outcomes. The data was analyzed with descriptive statistics and associations were analyzed via phi correlation coefficient.
Results: 1498 patients received a diagnosis of LE at presentation. The average age at presentation was 58.3 and 57% were male. Of the original 1498 patients, 594 returned for a second visit, 525 received a corticosteroid injection, and 279 received a second corticosteroid injection. 105 patients underwent magnetic resonance imaging (MRI) of the elbow, and 17% of these patients ultimately had surgery. In the entire cohort, 45 underwent surgical reconstruction, 50 underwent treatment with PRP, and 7 had surgery combined with PRP. Associations analyzed with Phi coefficient demonstrated that patients who underwent a 2nd corticosteroid injection were statistically likely to undergo a 3rd injection. It also demonstrated that patients who had surgery usually had had one corticosteroid injection, but were unlikely to have had multiple injections. Patients followed up for an average of 11.46 months and had an average of 2.09 visits.
Conclusion: Lateral epicondylitis is a common complaint that, in the majority of cases, required only conservative treatments and a single visit to a hand surgeon. Of the patients who were treated with corticosteroid injection, 53% received a second injection, and Phi correlation coefficients demonstrated that those who received a second injection were likely to receive a third as well. Only 3.5% of patients who presented with lateral epicondylitis underwent surgical intervention.
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