Tennis elbow surgery

In case of a tennis elbow, microscopic ruptures occur initially due to the overload of certain muscle groups, and repeated traumas, then in a subset of cases, macroscopically visible ruptures occur in the muscle. Conservative (non surgical) treatment has special importance in case of tennis elbow, but a surgical procedure is performed if that is ineffective.

Tennis elbow is an overuse injury, which develops at the insertion area of the forearm extensors, at the outer side of the elbow joint. It most commonly develops as the consequence of repeated microtraumas. It could develop not only in tennis players, but also in people who do other sports, or physical labor. However, keep in mind that the development of a tennis elbow, and the prolongation of complaints, which started as a consequence of loading, but which did not improve by treatments, could also be caused by the presence of an inflammatory focus in the body (inflammation that is present somewhere else). These foci could be most commonly dental or laryngeal, urological in men, and gynecological in women. Sometimes smaller bone spurs may develop at the outer side of the elbow, which cause pain that is unresponsive to treatment.

What treatment options are available?

Non surgical treatment

The treatment must be started with an investigation in every case. An X ray must be done to rule out other pathologies with similar symptoms. Afterwards, forearm stretching exercises and physiotherapy is recommended with non steroid anti inflammatory drugs, which may be complemented by other physical therapy treatments. If the complaints remain unchanged with the treatments, a more complex investigation is recommended with focus search, and laboratory tests. If the cause is revealed during these examinations, then the treatment must be continued at the affected area – dentistry, urology, gynecology, laryngology, rheumatology. If the cause is eliminated, then the complaints usually resolve within a few weeks or months. The symptoms and the pain may persist in other cases. This could be resolved by the repeated intake of anti inflammatory drugs, and application of physical therapy treatments. Surgery is performed if joint pain, swelling still persist despite of the above treatments.

Surgical treatment

The tightness of the forearm extensors is reduced during surgery. This could be achieved by moving the insertion zone of the tendons a bit further down. If bone spurs were confirmed by X-ray images, those are removed as well. Usually, exercises may be started on the first day after surgery according to the instructions given by the treating physician and the physiotherapist. It is recommended to regularly perform the practiced physiotherapy exercises at home, and unload the operated limb, if necessary. Generally, a resting period of 4-6 weeks is recommended after the intervention. In non problematic cases, the patients are discharged home on the first day after surgery.

How is the surgery performed?

During surgery, an incision of 2-3 cm is made on the outer side of the elbow. Following this, the insertion zone of the forearm extensors is located, then its tightness is resolved by making an incision on it, and the insertion zone is moved a bit further down. If bone spurs were confirmed by X-ray images, those are removed as well. Surgical hemostasis is performed after the surgery, and if necessary, a small drain is inserted, which removes the secretions and hematoma that developed after surgery. Elastic bandage is applied on your forearm and elbow after the surgery.

What happens if the justified surgical treatment is not performed?

The pain will persist causing additional subjective inconveniences, or potential difficulties in movement. Surgical treatment holds out smaller success if it is done after a chronic, long term inflammation.

Why is regular physiotherapy important?

In order to restore the full joint function following the surgery, it is essential to practice the exercises at home too, which were given by the physiotherapists. This supports the restoration of the joint functions.

When can you return to your daily activities?

Some types of sedentary work are allowed after surgery, but doing physical labor, and using training loads can only be started about 6 weeks after the intervention. You may start sport activities which load the lower limbs e.g., running, already a few weeks after the surgery.