Tennis Elbow (Lateral Epicondylitis) Surgery: All You Need to Know

Overview

Tennis elbow, also known as lateral epicondylitis, is a distressing condition caused by the overuse of the elbow. Inevitably, participating in sports that involve racquets, such as tennis, can result in this condition. Yet a number of other activities and sports can put one at risk.

Tennis elbow is an inflammation of the tendons connecting the muscles of the forearm on the outer side (lateral) of the elbow, or in certain cases, a micro tear of these tendons. Excessive use or repeatedly performing the same motions damages the muscles and tendons in the forearm. This results in tenderness and pain on the outside of the elbow.
For treating tennis elbow, there are numerous treatment options available. In most cases, it involves a collaborative approach involving primary care physicians, physiotherapists, and, in certain instances, surgeons to provide effective care.

Tennis elbow surgery is indicated when conservative treatment approaches have failed to relieve the pain and grip strength loss brought on by this overuse condition.
This page talks about tennis elbow surgery or lateral epicondylitis surgery, how to prepare, what to expect before and after the surgery, and more.

What is Tennis Elbow (lateral epicondylitis) Surgery?

Lateral epicondylitis surgery typically involves cutting the damaged or affected tendon where it joins the lateral epicondyle (outer side of the elbow), eliminating the inflamed or scar tissue surrounding the tendon, and, in certain cases, reattaching the free end of the tendon to the fascia (adjacent soft tissues). This surgical procedure for addressing the affected tendon can be performed using various methods. These methods include:

• Open Surgery: It involves making a larger incision using a scalpel
• Arthroscopic surgery: It utilises a narrow scope and specialised equipment through a small incision
• Percutaneous surgery: This involves a small incision without the use of a scope.
  It is worth noting that there is no significant difference in effectiveness between these three approaches.

Do all cases of tennis elbow require surgery?

Tennis elbow does not always require surgery and is typically considered a treatment option when other non-surgical methods have been unsuccessful in providing relief. Research suggests that only around 10 percent of individuals diagnosed with tennis elbow are advised to consider surgery.

Before surgery is considered, various non-surgical treatments may be explored, such as giving rest to the affected area and using over-the-counter pain relievers. Other options may include platelet-rich plasma injections (PRP), ultrasonic tenotomies, or physical therapy.

Surgery is typically not recommended unless the individual has not experienced improvement after trying these alternative treatments for a period of 6 to 12 months.

How to prepare for the Tennis Elbow Surgery?

To prepare for tennis elbow surgery, follow these steps:

• Meet with the surgeon to discuss the procedure, ask questions, and understand the benefits, risks, and chosen surgical approach.
• It is important for the patient to inform the surgeon about all medications they are taking, including over-the-counter medicines, herbs, supplements, and vitamins. This includes discussing the use of medicines such as aspirin, ibuprofen, naproxen, or warfarin. The patient should consult with the surgeon before making any changes to their medication regimen. The patient should seek guidance from their doctor regarding which medications they should continue taking on the day of the surgery.
• If the patient is a smoker, it is advised to stop smoking before the surgery, as smoking can impede the healing process.
• Lateral epicondylitis surgery is typically performed in an operating room within a hospital or a specialised outpatient orthopaedic surgical centre.
• Wear comfortable clothing that can be easily taken off and put back on. Upon arrival, patients will be asked to change into a hospital gown and remove all jewellery, hairpieces, hearing aids, lip or tongue piercings, and dentures.
• Depending on the type of anaesthesia used, the patient should follow instructions regarding fasting, which means refraining from eating or drinking anything for the specified period before the surgery.
• The patient should arrive at the surgery centre at the designated time instructed by the surgeon or nurse, ensuring punctuality.

What to expect before the tennis elbow operation?

Prior to the surgery, the patient’s height, weight, and vital signs, including blood pressure, temperature, and heart rate, will be recorded by the nurse. These measurements are important for determining the appropriate dosage of anaesthesia.
In some cases, if deemed necessary, the nurse may shave the surgical site to ensure a clean and sterile environment.

If the patient is to receive regional or general anaesthesia, an IV line will be placed into a vein in the patient’s arm. This IV line will be used to administer fluids and medications during the surgery.

Additionally, the patient’s blood oxygen levels will be continuously monitored using a pulse oximeter, which is a device that clamps onto a finger. Electrode leads may also be placed on the patient’s chest to connect to an ECG machine, allowing for continuous monitoring of the patient’s heart activity.

What to expect during the Tennis Elbow (Lateral Epicondylitis) Surgery?

During tennis elbow surgery, you will be positioned on the operating table in a supine position with your arm placed on an elevated arm table.

Anaesthesia

Anaesthesia will be administered, which can be local, regional, or general, depending on the type of surgery and extent of repair needed.

• If local anaesthesia is used, a tourniquet is applied to limit the spread of the anaesthesia. It is then injected into and around the joint using a syringe and needle.
• When regional anaesthesia is used, it involves delivering the anaesthesia through an IV line while using a tourniquet. In some cases, monitored anaesthesia care (MAC) may be used to induce a ‘twilight sleep’.
• General anaesthesia is typically used for extensive joint repair and is administered through an IV line to put the patient to sleep completely.

Tendon Release

The tendon release procedure, regardless of the surgical approach, involves the following steps:

• An incision is made over the lateral epicondyle, the bony prominence on the outer side of the elbow.
• The soft tissue surrounding the area is gently moved aside to expose the extensor tendon.
• The extensor tendon is cut at the lateral epicondyle to release it from its attachment.
• The tendon is then split to provide access to the underlying tissues and bone.
• Any bony growths, known as osteophytes, are removed using cutting or scraping instruments, and the area is thoroughly cleaned.
• The split tendon is carefully sutured back together using self-absorbable sutures.
• In some cases, surgeons may also attach the loose end of the tendon to nearby tissue to prevent retraction.
• The external incision is closed using stitches, and a sterile bandage is applied to protect the surgical site.

What to expect after the Tennis Elbow Operation?

After the surgery, the patient will be monitored until the effects of the anaesthesia subside. During this time, the healthcare professionals will check if there are any adverse reactions associated with the medications and anaesthesia used during the surgery.

It is quite common to experience pain around the site of surgery for the first few days. Healthcare professionals might give patients pain relieving medications to ease this pain. Additionally, if the surgery was extensive, they may prescribe high-strength pain-relieving medications for the initial few days, if necessary.

Once the patients are steady, and their vitals have normalized, they will be allowed to change their clothes. It is essential to have a responsible person accompany patients to drive them home after the surgery. This ensures safety and allows for proper postoperative care.

Recovery after the Surgery

Surgery for tennis elbow requires a relatively long recovery period. It involves:

• Keeping the arm in a sling for 7-10 days and keeping it elevated and supported with pillows to reduce pain.
• Ice therapy and changing bandages as directed are recommended.
• Stitches are typically removed during a follow-up visit, and a smaller splint may be worn for an additional 2 weeks.
• After the splint is removed, rehabilitation exercises under the guidance of a physiotherapist will be gradually introduced, starting with passive exercises and progressing to resistance training. Additional exercises and therapies may be added to improve strength and range of motion.
• Full recovery and return to normal activities typically occur within 12 weeks, but sports or heavy lifting may require an additional 4-10 weeks of healing.

Potential Risks associated with the Surgery

Although minimal, tennis elbow surgery carries certain risks, similar to any other surgical procedure. This is due to the procedure’s proximity to delicate structures, which are prone to damage.

Surgery on the tennis elbow can pose the following risks:

• Infection following surgery
• Injury to the radial nerve that results in tingling, numbness, or loss of sensation in the back of the forearm and hand
• Elbow dislocation (chronic)
• Allergic reaction to anaesthesia
• Blood clots
• Bleeding
• Reduced range of motion in the elbow
• Loss of strength in the forearm

Takeaway

A lateral epicondylitis release surgery can be beneficial for individuals with tennis elbow, but it should not be considered a quick solution. It necessitates several months of rehabilitation and a dedicated commitment to the rehabilitation program.

If conservative treatments have been attempted for 6 to 12 months without success, it is important to reflect on whether all possible non-surgical options have been explored to improve the condition. By evaluating the situation honestly, one can make an informed decision regarding whether tennis elbow surgery is the appropriate treatment choice.