Is There A Surgery For Tennis Elbow?[1]
Yes, there is a surgery for treating tennis elbow and there are several surgical methods available for treating tennis elbow. Usually tennis elbow is self-limiting; however, 4% to 11% of patients develop a chronic stage where the pain remains even with proper medical therapy. Surgery is recommended for patients diagnosed with tennis elbow and who have been on medical therapy, physiotherapy at least for six months without any improvement in the condition. Before considering surgery it is important to exclude other conditions that mimic tennis elbow.
In all the surgical methods, the damaged tendon parts are removed and combine the healthy tendon parts together. There are several surgical options and the best option for you will depend on the degree of your injury, physical fitness, and other medical conditions. You need to consult a surgeon and discuss with them the advantages and disadvantages of each surgical option of tennis elbow and then choose wisely the best option.
The surgical options all involve removing of the dead tissue. This can be done in several ways
- Open approach
- Arthroscopic approach
- Ultrasonic percutaneous tenotomy.
Open Surgery For Tennis Elbow[2]
Open method (Nirschl and Pettrone) that is done today includes removing of the dead tissue part of the tendon (extensor carpi radialis brevis) and then suturing the remaining healthy tendon parts together. Studies done on the patients who underwent this method has shown significant pain reduction after tennis elbow surgery. About 85% of patients return to normal movement without any pain. This needs an incision in the elbow and usually it is done as an outpatient surgery and does not require overnight stay.
Arthoroscopic Approach Surgery For Tennis Elbow[3]
Arthoroscopic method tennis elbow surgery involves small cuts in the elbow and the small equipment and a camera will be inserted through this cuts. Then, the damaged parts of the tendon are removed. The advantages of arthroscopic method over open method is it’s minimally invasive, early recovery and can see if there are any other problems in the joints, tendons. However, there is a possibility of damage to a ligament in the elbow, but with an experience surgeon this is a rare possibility.
Studies have not shown any clinical difference in the outcome of open or arthroscopic surgery. Both methods are effective in relieving pain in chronic tennis elbow.
Ultrasonic Percutaneous Tenotomy For Tennis Elbow
This is less invasive than the open method. The tendon of the muscle (extensor carpi radialis brevis) is repeatedly perforated using a small microsection device under ultrasound guidance. A study was done on patients who underwent this tennis elbow surgery method with follow up for 3 years and reported all cases showed pain relief after the tennis elbow procedure. This method is done as an outpatient surgery and usually does not require overnight stay.
Complications of Surgery For Tennis Elbow[4]
The following risks can happen in any of the tennis elbow surgical methods mentioned above.
- Infection
- Nerve and blood vessel damage
- Need for further surgery
- Loss of strength and flexibility
- No improvement in the clinical status
- Longer rehabilitation
Post Surgery of Tennis Elbow
Arm will be immobilized using a splint for about 1 week. The stitches and splint removed after 1 week, then exercises should be started gradually, initially with the stretching exercises to restore flexibility, then the strengthen exercises can be initiated after about 2 months.
Usually 4 to 6 months after the surgery you can return to your athletic activity, but this should be confirmed with your doctor before starting. Usually surgery is successful in 80 to 90% of patients however sometimes loss of strength is seen in some patients.
Conclusion
Surgery is usually indicated at least after 6 months of unsuccessful medical therapy for tennis elbow. There are several surgical methods and these have an 80% of success rate. Before considering surgery other conditions should be excluded and then a suitable surgical method should be chose after consulting a doctor. There are three surgical approaches for tennis elbow, which are open surgery, arthroscopic surgery and ultrasonic percutaneous ultrasonic tenotomy. Studies have not shown any clinical difference in the open or arthroscopic methods, ultrasonic percutaneous tenotomy is newer technique where limited number of studies have been done.
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