Sumko, Dan
Wagner, Russell
Sumko, Michael H.


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This is a retrospective study involving patients with chronic lateral epicondylitis of the elbow. From 1996 through 2012, 108 elbows in 87 patients underwent TOPAZ (radiofrequency ablation) applied to the lateral epicondyle. Patients were contacted by phone and data collected which showed 86% excellent results with follow-up ranging from 2-18 years. This minimally invasive procedure proved to be an effective modality, with no significant complications, for the treatment of chronic tennis elbow. Purpose (a): To evaluate outcomes of TOPAZ radiofreqency coblation for recalcitrant lateral epicondylitis. Methods (b): The pool of subjects ranged in age from 41 to 72 and had a history of at least 3 months of conservative treatment to include NSAIDs, activity modification, bracing, night splints, and at least 3 steroid injections. All of these had failed to give any long term relief. Subjects were prepared for surgery by marking out the tender area on the skin in a usual rectangular shape. After adequate anesthesia, varying from local with sedation to general, a longitudinal incision was made in the mid-area of the pre-op delineated rectangular area. Most were done without the aid of a tourniquet. The radio-frequency (TOPAZ) tip was touched to the surface of the tendon every 3-4 mm, and every third touch penetrated the tendon surface to a depth of 3-4 mm. When the area of the tendon corresponding to the rectangular skin markings was treated, (making a checkerboard pattern) the wound was closed with subcuticular 3'0 monocryl suture and steri-stripped. A dressing of a simple fluff was held in place with a curlex roll and coban. The patient was instructed to keep the dressing dry until the first post op visit at day 7-10, with no excessive lifting (greater than one pound for 1 week and then no greater than 8 pounds for an additional 2 weeks). Return to normal activities was permitted at week 6 weeks. 87 patients who had undergone TOPAZ radiofrequency coblation therapy for lateral epicondylitis by the same surgeon during a period from 1996-2012 were contacted via telephone. In addition to eliciting the Numeric Pain Scale for the operative elbow, the patients were also asked a series of additional questions pertaining to their satisfaction and results of the procedure seen below. "Was the procedure performed on your right or left elbow? Or Bilaterally?* How would you rate the overall results of your procedure on a scale of 0-10, 10 being a perfect outcome? Does your elbow have a negative impact on your daily activities? Never, Occasionally, Always? How would you rate the appearance of the scar from the procedure, on a scale of 0-10, 10 being a perfect scar that is hardly noticeable? How would you rate your pain since the procedure, on a scale of 0-10, 10 being excrucitating? Postoperatively, do you experience a decreased range of motion? Postoperatively, do you experience any weakness on that side? 8. How would you rate your overall relief of previous pain: Total, Partial, or None? *If both elbows were operated on, questions 2, 4, & 5 were asked for both sides separately." Results (c): Of the 87 patients surveyed, 21 had received TOPAZ bilaterally accounting for 108 total elbows. Male 45% Female 55%. Age - Mean: 56 years old (s=7.85) Years Since Procedure Mean: 9.2 years (s=3.39). Left Elbow 43% Right Elbow 57%. Bilateral TOPAZ 24% Overall Satisfaction out of 10 Mean: 8.6 (s=2.17) Negative impact on ADLs? No: 86% Yes:8% Partially: 7% Appearance of Scar out of 10 Mean: 7.50 (s=2.31) Pain Since Surgery (Numeric Pain Scale) Mean: 1.70 (s=2.81). Experience decreased ROM? None: 98% Partial: 2% Complete: 0% Experience weakness? Never: 87% Sometimes: 11% Always: 2% Relief of symptoms - Total: 86% Partial: 10% None: 4% Conclusions (d): TOPAZ has been shown to be an effective, minimally invasive modality for treatment of recalcitrant lateral epicondylitis.