Tennis Elbow Surgery (Tendon Repair)
Overview
Tennis elbow, medically known as lateral epicondylitis, is a painful condition that results from inflammation of the tendons attaching to the outside of the elbow. Caused by repetitive movements and overuse, this condition is common in tennis players and other racquet sport athletes who repeatedly use their forearm muscles, however it can also be seen in those who engage in any regular, repetitive arm motions.
When traditional tennis elbow treatment options such as rest, physiotherapy, braces and injections fail to provide relief, tennis elbow surgery can offer effective pain resolution, with a success rate of up to 95% for eligible patients. Surgery is usually considered in patients with symptoms for greater than 6 months, and who have tried at least three months of physiotherapy, injections or other non-operative treatments, with little or no improvement.
Anatomy of the Elbow
Fig 1. Elbow Anatomy
The elbow is a hinge joint formed by three bones:
- the humerus (upper arm bone)
- the radius (forearm bone)
- the ulna (forearm bone)
Muscles, tendons, and ligaments surround these bones to stabilise the joint and allow for smooth motion.
Tennis elbow specifically affects the tendons that attach the forearm muscles to the lateral epicondyle, a bony prominence on the outer part of the elbow. When the extensor tendons, particularly the extensor carpi radialis brevis (ECRB) tendon, are repeatedly strained or overloaded, small tears and inflammation develop, resulting in pain and tenderness along the outer elbow.
What is Tennis Elbow Surgery?
When conservative treatments fail to relieve tennis elbow symptoms, surgical intervention may be considered. Tennis elbow surgery, also called lateral epicondylitis repair, typically involves removing the damaged portion of the ECRB tendon and repairing healthy tendon to the bone. In some cases, a small portion of bone near the affected tendon is removed to promote blood flow and expedite healing.
This surgery can be performed through various methods, including:
- Open Surgery: A traditional approach where a small incision is made to access and repair the tendon directly.
- Arthroscopic Surgery: A minimally invasive procedure that uses small incisions and specialised instruments to remove damaged tissue.
- Percutaneous Release: A newer technique where the tendon is treated using tiny incisions with minimal disruption to surrounding tissues.
The choice of technique depends on factors such as the extent of the damage, the patient’s lifestyle, and the Mr Chua’s recommendation.
Benefits and Risks
The primary benefit of tennis elbow surgery is substantial pain relief through the removal of damaged tissue, allowing patients to regain function and resume daily activities, including sports and work. Most patients experience a significant reduction in symptoms, with surgery offering a high success rate, improving the quality of life for those with persistent tennis elbow symptoms.
As with any surgical procedure, tennis elbow surgery carries some risks, including:
- Infection at the incision site
- Nerve injury, potentially leading to weakness, numbness, or tingling
- Stiffness, which may limit the elbow’s range of motion
- Incomplete pain relief in some cases, resulting in continued discomfort
What To Expect
Before Surgery
Surgery is generally recommended only after non-surgical treatments have been tried for at least 6 months. A pre-operative assessment will be conducted to ensure fitness for surgery. Patients will receive instructions on medication management, fasting, and post-operative arrangements.
During Surgery
Tennis elbow surgery is usually performed as a day procedure, allowing patients to return home the same day, although some may stay overnight for comfort. Anaesthesia is administered, either local or general, depending on patient preference and the approach chosen for surgery. Mr Chua will remove the damaged portion of the tendon, reattach healthy tissue to the bone, and potentially remove a small portion of bone to increase blood flow. After the procedure, the incision is closed with dissolvable stitches and covered with a waterproof dressing.
After Surgery
Post-surgery, patients should expect to rest the affected arm for 1-2 weeks. A temporary sling may be recommended to immobilise the arm, reducing movement and aiding initial healing. Pain management will be supported with prescribed medications.
After the split or sling is removed, a physiotherapist will guide the patient through a rehabilitation plan, which includes exercises to stretch and restore flexibility to the elbow, followed by gradual strengthening of the forearm, wrist, and shoulder muscles. Proper rehabilitation is key to recovery, helping restore function and reduce the risk of recurrence. Full recovery typically spans 3-6 months, with most patients returning to daily activities well before this time.
Frequently Asked Questions
- How long will it take to recover fully from tennis elbow surgery? Recovery time varies depending on the extent of the surgery and the patient’s overall health. Most patients regain functional use of the arm within 6-12 weeks, but complete recovery, particularly for sports or physical activities, can take up to 6 months.
- Will tennis elbow surgery leave a visible scar? Most surgical scars are small and fade over time. In open surgery, a small scar may be visible near the elbow, but minimally invasive techniques can reduce scarring. Using proper post-surgery scar care, such as silicone gels and sun protection, can also help.
- Can tennis elbow surgery eliminate my symptoms completely? Surgery has a high success rate, with 80-95% of patients experiencing significant symptom relief. However, a small number of patients may experience residual symptoms or mild discomfort even after recovery.