American Board of Internal Medicine (ABIM) Certification Practice Exam

When should surgical treatment be considered for lateral epicondylosis?

1. For all patients

2. Only in refractory cases

3. After 6 weeks of conservative therapy

4. When there is significant joint degeneration

The correct answer is: Only in refractory cases

Surgical treatment for lateral epicondylosis, commonly known as tennis elbow, is generally considered in cases that do not respond to conservative management. This conservative approach typically includes rest, physical therapy, non-steroidal anti-inflammatory medications, and other non-invasive measures. When symptoms persist despite these treatments, usually for at least 6 months, surgery can be an appropriate next step. Choosing to perform surgery on all patients is impractical and unnecessary as most individuals will find relief through conservative measures. Surgical interventions carry risks and may not be suitable for everyone. Similarly, initiating surgical options solely based on the duration of conservative therapy without considering the patient's response to treatment does not align with current practices. Additionally, significant joint degeneration may warrant surgical intervention, but this is not the primary indication for surgery in cases of lateral epicondylosis, as the condition often does not involve true joint degeneration but rather pathology of the common extensor tendon. Thus, the recommendation to limit surgical treatment to those cases that are resistant to conservative therapy aligns with the evidence and clinical guidelines, ensuring that surgery is a viable option only when absolutely necessary.