Nirschl Surgery for Tennis Elbow

Lateral epicondylitis or tennis elbow can become a chronic problem with pain and loss of function. For most people, non-operative care prevents the acute problem from becoming chronic. But in a small number of patients, surgery may be needed. There are many operative techniques for the surgical treatment of lateral epicondylitis.

In this study, long-term results of the Nirschl approach are reported. In 1979, Dr. Nirschl and an associate discovered that chronic tennis elbow was not an inflammatory condition. Instead, there are changes at the cellular level that show a degenerative process more accurately called tendinosis.

The Nirschl technique was devised to treat this problem. The tendinosis tissue within the extensor carpi radialis brevis (ECRB) tendon was removed. Any damage to the extensor carpi radialis and extensor digitorum communis (EDC) tendons was repaired. The ECRB was not repaired because that puts the elbow at risk for a flexion contracture. With a flexion contracture, the elbow doesn't straighten all the way. In other words, there is a loss of elbow extension.

A mini-open approach was used for the Nirschl procedure. This means only a small incision is made. This is a slight modification from how the original Nirschl approach was done in 1979. Short-term results from this surgery were reported as very good to excellent for 85 per cent of the patients. Patients were able to return to full activity. Athletes involved in sports were able to resume an activity level equal to their pre-injury level.

Long-term follow-up was a minimum of 10 years after the operation. Patients were contacted by phone and interviewed about pain, motion, function, and satisfaction. Good to excellent results were reported by 84 per cent of the patients. Good was defined as slight or occasional elbow pain with strenuous activities. Some patients had a sight loss of grip strength. An excellent result meant there was complete pain relief and full grip strength.

The majority of patients (92 per cent) contacted were able to return to full participation in their previous sport. Most were involved in tennis, but others were golfers, weight lifters, racquetball players and martial arts athletes. The authors reported there were some problems collecting follow-up data on many of the patients. But their limited results confirm that removing tendinosis tissue and sparing normal tissue in the lateral elbow (the Nirschl procedure) for epicondylitis gives durable long-term results.

References: Johnathan H. Dunn, MD, et al. Ten- to 14-Year Follow-Up of the Nirschl Surgical Technique for Lateral Epicondylitis. In The American Journal of Sports Medicine. February 2008. Vol. 36. No. 2. Pp. 261-266.