What is Tennis Elbow?
Tennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a painful condition occurring from repeated muscle contractions at the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments.
Symptoms of Tennis Elbow
Patients with tennis elbow experience elbow pain or burning that gradually worsens and a weakened grip
Diagnosis of Tennis Elbow
Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, MRI or electromyogram (EMG) to detect any nerve compression.
Treatments of Tennis Elbow
Your doctor will first recommend conservative treatment options to treat the tennis elbow symptoms. These may include:
Limit use and rest the arm from activities that worsen symptoms.
Splints or braces may be ordered to decrease stress on the injured tissues.
Apply ice packs on the elbow to reduce swelling.
Avoid activities that bring on the symptoms and increase stress on the tendons.
Anti-inflammatory medications and/or steroid injections may be ordered to treat pain and swelling.
Physical therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
Pulsed ultrasound may be utilized to increase blood flow and promote healing to the injured tendons.
If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope –narrow lighted tube with a camera). Your surgeon will decide which option is best for you depending on your specific circumstances.
Your surgeon moves aside soft tissue to view the extensor tendon and its attachment on the lateral epicondyle. The surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the incision(s) are closed by suturing or by tape.
Following surgery, you are referred to physical therapy to improve the range of motion and strength of your joint.
Lateral Epicondyle Release Surgery
If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend you undergo a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Surgery is considered a last resort for this condition and only 1 in 10 patients requires surgical intervention. The surgical success rate for relieving Tennis Elbow pain is 85-95%.
Your surgeon will decide whether to perform your surgery in the traditional manner or endoscopically. Traditional surgery involves up to a 2” incision in the elbow area, whereas endoscopic surgery involves one or two ½” incisions and the use of an endoscope with a camera for viewing internal structures. The television camera attached to the endoscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the elbow joint at cartilage, ligaments, nerves and bone. The goal of tennis elbow surgery is to remove the diseased tissue around the outer elbow, improve blood supply to the area, and alleviate the patient’s symptoms. This surgery is usually performed in an operating room under regional or general anesthesia on an outpatient basis as day surgery.
Your surgeon makes one or two small incisions, about ½ inch each, to the outer elbow area, the lateral epicondyle. Each incision is called a portal. These incisions result in very small scars, which in many cases are unnoticeable. A blunt tube, called a Trocar, is inserted into each portal prior to the insertion of the endoscope and surgical instruments. With the images from the endoscope as a guide, the surgeon can look for any pathology or anomaly. The large image on the television screen allows the surgeon to see the joint directly and to determine the extent of the problem. The second portal is used for the insertion of surgical instruments. This portal will be used to move aside soft tissue in order to view the extensor tendon and its attachment on the lateral epicondyle. The surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs.
Postoperative Care Following Surgery for Tennis Elbow
After the surgery is completed, the portals (incisions) are closed by suturing or by tape. Endoscopic surgery is much less traumatic to the muscles, ligaments, and tissues than the traditional method of surgically opening the elbow area with long incisions. After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon’s preference.
Risks and Complications of Tennis Elbow
As with any major surgery, tennis elbow surgery may involve certain complications such as:
Allergic reactions to medications
Heart attacks, strokes, kidney failure, pneumonia, bladder infections
Radial nerve damage causing numbness, tingling, burning or loss of feeling in the back of the hand and forearm area
Wrist weakness with extension
Symptoms recur or do not improve