Eccentric Exercise or Radiofrequent Microtenotomy as Treatment of Lateral Epicondylalgia

Of those affected by lateral epicondylalgia will 90% be free of symptoms within 8 months to 2 years with conservative treatment. In this study surgical radiofrequency microtenotomy and eccentric exercise for chronic (more than two year) lateral epicondylalgia that is unilaterally will be used as treatment. Patients is randomized to a group with eccentric exercise or a group with surgical radiofrequency microtenotomy and postoperatively eccentric exercise. Home based eccentric exercise program is instructed by a physical therapist and is performed for three months. Women start with 0.5 kg and men 1.0 kg weight, they perform 3 sets with 5 reps once a day and register pain and exercise in a diary. Function, pain and quality of life will be followed and are carried out after 6 weeks and after 3, 6 and 12 months. The surgery and eccentric exercise is instructed and followed at the investigators clinic.

• Radiofrequency microtenotomy (Procedure), also known as Minimally invasive surgery: For the minimally invasive surgery will Arthrocare Topaz MicroDebrider device be used. A small incision will be made and the tip of the device is placed on surface of the tendon to structure and activated for 0.5 second, at 5 mm distance intervals on the tendon creating a grid-like pattern.
• Eccentric exercise (Other): Eccentric exercise for 3 months. The exercise will be performed once a day with 3 set and 5 reps, women start with 0.5 and men 1.0 kilo with a 10 % increase every week.
• Arthrocare Topaz MicroDebrider (Device)

Primary outcomes

• Function. [12 month]: Function measured with the DASH (Disability of Arm-Shoulder-Hand) Questionnaire and Jamar dynamometer as static maximum grip strength.
• Pain. [12 month]: Pain estimated with Visual Analogue Scale (VAS 0-100 mm).

Secondary outcomes

• Quality of life. [12 month]: The Short Form-12 (SF-12) is a questionnaire which measures Quality of Life (QoL), which are both physically and emotionally based.

Sex: All, ages: 18 Years to 70 Years

Inclusion Criteria:

* over the age of 18 and under the age of 70 year
* lateral epicondylalgia at least two year
* tried conservative treatment

Exclusion Criteria:

* complicated systemic diseases (such as diabetes)
* understand spoken and or/written instructions in Swedish

• Annette Heijne, PT, PhD, Study director, Karolinska Institutet