Surgical Treatments for Chronic
Tennis Elbow Pain
So You've Tried all of the Conservative Therapies Available...
Conservative treatments for Tennis Elbow are typically very successful. Only 10% of people suffering from Tennis Elbow will ever need surgery. In fact, most doctors and surgeons will recommend 6 to 12 months of conservative treatment before surgery will even be considered. If constant pain, immobility, and inflammation from your Tennis Elbow is greatly interfering with your quality of life, and you've tried every conservative option available to you. Your physician may present surgery as an option to relieve your pain.
Lucky for you, approximately 80 - 90% of Tennis Elbow procedures are successful. Tennis Elbow surgery will focus on 2 main things...
- Removing damaged tissue in your elbow while repairing your tendon
- Stimulating your body’s natural healing process
By getting rid of weak and damaged tissue built up in your tendon from repeated injury and overuse, you can begin to re-strengthen your elbow to avoid further injury. When conservative treatments fail, surgery may provide pain relief and return elbow function that you need to get back to your job, your recreational activities, and your life.
While most studies show that complications arising from Tennis Elbow surgery are rare, there are always risks associated with any surgical procedure. The most common risk factors associated specifically with Tennis Elbow surgery include permanent loss of some elbow strength, range, or mobility. During operation, surrounding blood vessel and nerve damage can occur. Modern surgical techniques and guidance imaging devices have been developed to help physicians in Tennis Elbow surgery. As with any surgical procedure there are risks. It is always best to talk to your orthopaedic surgeon before and after surgery to discuss all possible risks and complications.
You should expect some tenderness, pain, and stiffness after the surgery. The surgical procedure his after all re-injuring your elbow to encourage proper healing. These symptoms are common after surgery and will be reduced if you commit to conservative treatments and physical therapy during your rehabilitation.
Learn more about Post-Surgery Rehabilition and Recovery for your Tennis Elbow Surgery
Open Release Surgery
The most common surgery used to treat Tennis Elbow is Open Release Surgery. There are two different techniques that can be used. Traditional open release and open release with drilling have both been successful in treating Tennis Elbow.
Open Release is performed through a 2.5 - 7 cm incision created in the skin on the outside of the elbow above your epicondyle. This incision exposes the ECRB (exstensor capis radialis brevis ) forearm muscle beneath the skin. Another incision in the muscle gives the surgeon access to the tendon and its attachment to the lateral epicondyle bone. The surgeon will either remove any damaged weakened tissue, or repair tears to the tendon tissue. Your surgeon may be partially or even completely cut your tendon away from the lateral epicondyle. This allows the forearm muscle to relax.
Scar tissue that has built up through repeated injury and overuse is removed through a process called Debridement. During the removal of scar tissue and normal wear and tear, the elbow can become rough. The surgeon will abrade the bone of your elbow. This smoothes out the roughness of your elbow and removes any hardened tissues.
A technique called decortication can be used at this point. With this procedure, several 2 mm holes are drilled into the bone to stimulate blood flow to the area.
Bone and cartilage debris is taken away and sutures are installed using anchors to reattach your tendon to your bone. The surgeon will use dissolving stitches to seal the first cut made in your skin. Your arm will be placed in a splint or cast to keep from moving your elbow until your doctor says you are ready to begin light movements.
A 2001 study published in the British Medical Journal evaluated open and arthroscopic release surgeries. While both were found to be successful in the long term, drilling was no more effective in treating Tennis Elbow than traditional open release surgery. In fact, patients who underwent the drilling procedure were found to have more pain, stiffness, and bleeding of the wound than non-drilling patients during recovery.
Arthroscopy for Tennis Elbow involves creating very small inscisions in your skin at and around the epicondyle. These incisions act as entry points for thin tubular instruments to be inserted into your elbow. One of these tools is a small high powered camera that uses a fibre optic lens to record the inside of your elbow. Fluid is injected into your joint so the camera can give a clearer image and the surgeon has a better view of your elbow during the procedure. The images captured by the lens are sent to a television screen so that the surgeon has a magnified view of the inside of your elbow.
The surgeon will inspect your elbow joint and see if there are any other issues such as arthritis. Once your elbow has been fully checked out another incision is made so that tools for removing tissue and tendon repair can access your elbow. Using the guidance of the imaging on the television screen, the surgeon uses a sharp tool to remove inflamed and damaged tissue.
Another tool cuts away part or all of the tendon depending on the amount of damage. Once the scar tissue and hardened joint tissues are removed, the epicondyle is smoothed. Anchors are drilled into the bone to help sutures re attach the tendon to the bone. Once this is done, the tools are removed and the incision points are stitched shut. Your arm is splinted to prevent movement.
While both Open Release and Arthroscopic surgeries are 80 - 90% effective, arthroscopic surgeries have the added benefit of:
- smaller incisions to access the elbow
- reduced risk of blood vessel or nerve damage
- diagnostic ability so that the surgeon can see if there are any other injuries (like arthritis) present
- reduced risk of infection after surgery
- decreased amount of post-surgery recovery time allowing you to tretun to work and/or athletic training much more quickly
The Journal of Shoulder and Elbow Surgery, showed 91 - 98% success rate for full symptom relief of Tennis Elbow after arthroscopic surgery. Since arthroscopy can not only repair known injuries but also identify other conditions, this study concludes that arthroscopic surgery could be more beneficial than other surgical options available for Tennis Elbow.
Percutaneous Tenotomy Surgery
Percutaneous Tenotomy is a new alternative form of surgery for Tennis Elbow. This procedure was recently introduced in the early 2000's. Studies are still being conducted to verify the effectiveness of percutaneous tenotomy, and luckily all have shown positive results. This procedure does not need you to be put under like in open and arthroscopic procedures. The only entry points into your elbow are made through a hypodermic needle.
This procedure uses sonographic images similar to the ones pregnant mothers use to view their unborn baby. These images, created using imaging ultrasound waves help guide the surgeon while repeatedly penetrating the joint tissues of the elbow with the tip of the needle. The surgeon can feel when the tissues have become softer. Once hardened tissue has been broken up to allow access to the bone, the surgeon uses the head of the needle to smooth out the epicondyle. Removing damaged tissue without having to cut the tendon is one of the major benefits of percutaneous tenotomy.
The hypodermic needle is removed when the sonogrpahic images show that all of the hardened tissue has been broken up and the epicondyle is smooth. At this point your elbow will be injected with a shot of corticosteroid. This step is under review and future percutaneous surgeries may not require the coticosteoid injection at all. Medical tape is placed over the incisions and there is no need for stitches
Because this procedure doesn’t require you to be put under, it can be performed in a clinic or doctors office. Directly after the 20 minute surgery is completed the physician will help you to gently move your arm. Unlike open and arthroscopic surgeries, percutaneous surgery does not require you to wear a splint to keep your arm from moving. In fact without large incisions or sutures, the risk for infection is greatly reduced.
According to an article published on December 2nd, 2012 in the online US National Library of Medicine, many individuals found immediate pain relief after the soft tissues were broken up. This is however still a newer method of surgery, so there are probably many more studies to come about the overall effectiveness of this procedure.
Your doctor will recommend the surgical procedure that best fits your situation based on the severity of your Tennis Elbow and his/her experience with successful techniques. Each surgical procedure takes between 15-20 minutes to complete. In Open Release and Arthroscopic surgeries you will be put under using general anaesthesia. For all three of the above procedures, numbing medication will be injected into your elbow to temporarily block pain signals. A compression tourniquet or adrenaline injection is used to reduce swelling of the elbow during surgery. After the surgery you will be monitored and most likely released the same day. Out-patient (same day) surgery is common for all Tennis elbow procedures.
Whichever surgery is chosen, you will have to undergo physical therapy and conservative healing therapies after the operation. Depending on the amount of damage to your elbow before surgery, you could take anywhere from 1 day to several weeks before noticeable reduction in your Tennis Elbow symptoms occurs. Your physician should provide you with a rehabilitation program that will begin a few days or weeks after your surgery. Healing time and recovery will depend on the severity of your injury before surgery, the type of surgery performed, your age, and your overall health.
Being proactive is the best way to increase your chances successful recovery after surgery. If you keep your elbow immobile for too long or do not commit to conservative treatments after surgery, your chances of getting range of motion, grip strength, and fast relief from pain are greatly reduced. Cooling and warming therapies are essential in reducing swelling and stimulating blood flow to your elbow during healing. Speak to your physician about incorporating Elbow Freezie Wrap® and Elbow Inferno Wrap® into your post-operative program to optimize rehabilitation and decrease recovery time.
Using ColdCure Technology® and Blood Flow Stimulation Therapy™ (BFST®) alongside the physical therapies recommended by your physician will help you reduce recovery time and increase your chances of greater rehabilitative success. It is important that you consider most physicians will have already encouraged you to commit to trying conservative therapies before even turning to surgery. Surgery is not a quick fix option. Unless your physician determines you require surgery, conservative therapies using Elbow Inferno® and Freezie® Wraps will help you to achieve positive results faster.
Why let pain and decreased mobility stop you from living the quality of life you deserve? Incorporate conservative therapy into your post-surgery rehabilitation plan today to get back to your work, your activities, and your life!
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