Should I get surgery for tennis elbow?
Have you thought about getting surgery for your tennis elbow? Tennis elbow afflicts between 6.5 to 9.5 million people each year in the U.S. – and not just racquet sports players. Because it is caused by repetitive motions of the arms, this nagging injury affects golfers, gamers, musicians, construction and manufacturing workers, landscapers, hairdressers, cooks, butchers and even those who use a computer all day. It most often affects a person’s dominant arm.
As a result of overuse, damage to the tendons in the forearms can lead to pain, stiffness at the elbow, difficulty grasping or lifting objects and numbness or tingling in the fingers. Although symptoms may develop gradually, they tend to worsen over time and can become chronic if not treated.
Multiple treatment options exist – from conservative, over-the-counter methods to surgery. Patients are advised initially to rest the elbow, often combined with icing and pain medications like ibuprofen or acetaminophen. Braces or straps can offer temporary relief as well.
Professional therapeutic interventions include TENS, ultrasound and acupuncture to alleviate pain. Some physicians also will deliver injections of steroids like cortisone, or of platelet-rich plasma (PRP) to help reduce inflammation and stimulate healing.
Physical therapy may make use of some of these therapeutic options, along with manual therapy such instrument-assisted soft tissue mobilization (IASTM) and exercises to strengthen and stretch the muscles in the forearms to reduce strain on the tendons.
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After six months to one year of treatment, if a patient has not sustained relief from tennis elbow, the American Academy of Orthopedic Surgeons (AAOS) recommends that surgery may be considered. Fortunately, surgery is rare in tennis elbow cases, with only about 3% to 11% of sufferers requiring it.
Here’s what to expect if you’re wondering “Should I get surgery for tennis elbow?”
What happens in tennis elbow surgery?
There are no absolute contraindications to tennis elbow surgery. Prior to surgery, tests are administered to assess the extent of the injury. These may include an MRI to identify tears in the connective tissues or any bone fractures; a CT scan to show calcification of the soft tissues; and EMG to measure electrical activity in the nerves.
Surgery is typically performed in a hospital or outpatient surgical center, and general, regional or even local anesthesia is administered. You lie face-up on a table with your arm on an elevated table.
Tennis elbow surgery is known clinically as a lateral epicondylitis release, and it can be done in two ways:
- Open surgery – Requires a one-to-three-inch incision along the elbow
- Arthroscopic surgery – Uses a few tiny incisions and a narrow scope and camera
In the open procedure, the surgeon removes the damaged portion of the tendon and reattaches the healthy part back to the bone. In some cases, a tiny piece of the bone in the elbow also may be removed. With arthroscopy, the surgeon makes two to three small cuts in the skin and uses tiny instruments to remove the damaged parts of the tendon.
In both cases, the split tendon is stitched back together using dissolving sutures, and the external incision/s are closed with sutures and a bandage. The arm in placed in a splint to keep it bent at a 90-degree angle. You should be able to go home the same day.
The AAOS reports that tennis elbow surgery is effective in approximately 85% to 90% of cases. All surgeries have risk, although the rates of complications for open lateral epicondylitis surgery are 1.1%, and less than 1% for arthroscopic, according to a 2016 review of studies published in Orthopedic Clinics of North America.
- Tendon rupture
- Damage to nerves or blood vessels in the elbow
- Reduced strength or flexibility
You should contact your doctor if you experience the following after surgery:
- Severe pain
- Swelling that doesn’t subside
- Wound drainage
- Redness or skin color changes around the elbow
- Tingling or numbness in hand or fingers
You’ll likely feel some pain in the wound area, and you’ll have to wear a splint or sling for seven to 10 days to let your wound heal. Keep your elbow elevated when sitting to help ease pain, and use ice to decrease swelling. Pain relievers also can help.
Typically, you’ll visit your surgeon seven to 10 days after surgery, and you may have stitches removed and get a smaller splint to wear for another one to two weeks if necessary. You may be able to begin passive rehabilitation exercises, such as arm and shoulder stretches, and bending the fingers and wrists.
Once the splint is off, you will notice that your elbow is very stiff, and you will need to stretch and strengthen the arm to regain range of motion. Typically, patients work with a physical therapist to undergo a rehab regimen to perform exercises over six to eight weeks to improve strength in the arm, forearm and grip.
With consistent adherence to rehabilitation, most patients can resume normal activity after eight to 12 weeks; however, it may take as long as four to six months to return to exercise and sports. A 2018 review of the scientific journal, Hand, indicated that 95% of people who had open surgery for tennis elbow were “very satisfied” or “satisfied” with the results; and 93% of those who had arthroscopic felt the same way.
If pain persists beyond rehabilitation, speak with your doctor to determine and effectively address the underlying cause.