Fig. 2

Surgical procedure for lateral epicondylitis. a. As subcutaneous tissues are elevated, the fascia of the extensor muscle mass is exposed. The extensor aponeurosis and muscle fibers of extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) are visible. b. The proximal part of the interval between the ECRL and extensor aponeurosis is split and the ECRL is retracted anteriorly. Pathologic tendinopathy tissue of the ECRB (black arrow) is visually identified by its characteristic dull grayish color; it is usually edematous and friable. c. Excision of the pathologic and abnormal appearing tissue involving the ECRB, EDC tendon, and richly innervated periosteum at the site of the muscle’s origin is performed elliptically, leaving the normal tissue of the attachment to the lateral epicondyle. d. An oscillating saw is used to decorticate the lateral condyle. e. Drilling multiple small holes on the lateral condyle is performed to create a sufficient vascular bed. f. Anatomic repair of the interval between the posterior edge of ECRL and the common extensor aponeurosis performed without reattachment of the ECRB to its origin