Tennis Elbow Surgery


Before Surgery

In determining whether or not to use surgery to cure tennis elbow, the patient must first undergo the standard regimen for treating the ailment. The first practice to employ upon first experiencing the symptoms is the RICE treatment. This means Rest the arm, apply Ice to the affected area, put Compression on the affected area, and Elevate the arm. The compression is accomplished by wrapping the arm in a tennis elbow brace.

While doing the above treatment, an anti-inflammatory drug is taken. Most likely this will be Ibuprofen or something similar. If a doctor feels that a more aggressive treatment is necessary for the inflammation and resulting pain, cortisone shots will be injected into the patient's elbow.

The next part of the standard regimen for curing tennis elbow is physical therapy. Physical therapy in conjunction with the treatments mentioned in the first two paragraphs (except for the cortisone shots) is almost always the best course of action for treating tennis elbow. The full standard exercise regimen for curing tennis elbow can be found in these two books: Treat Your Own Tennis Elbow and How to Cure Your Tennis Elbow. The first book is a bit expensive; the second is immediately downloadable, and some say it is more helpful with the exercises.

By following this course of action, you should experience marked improvement within a couple of weeks, certainly no more then a couple months. So be aware as time goes on if your condition becomes only a slight inconvenience or are you unable to perform normal daily activities?

You probably already know that if you haven't been consistently and adequately treating your tennis elbow, it is not likely to disappear by itself. You may also have learned that if you prematurely get heavily into the activity that caused the problem in the first place, it will return.

When to Do Surgery

So now the question becomes, “What if your tennis elbow condition is severe, getting worse, or just not improving?” Well your doctor and orthopedic surgeon will most likely require that your tennis elbow condition be treated in the above manner consistently and appropriately for at least six months before deciding that surgery is in order. Of course there are other factors in determining if surgery is advisable. One of those factors certainly is how severe the condition actually is.

Also keep in mind that sometimes surgery does not correct tennis elbow. And in the rare case, more than one surgery must be performed to obtain the desired results. The range of estimates for surgical failure is 5 to 20%. Of course your doctor or surgeon can best help you get a feel for how successful your surgery is likely to be.

Keep in mind that in only the fewest cases is surgery required. The most respected surgeons perform the surgery only as a last resort. Also, except in those few cases, studies have not shown surgery to be more affective than the standard treatment.

What the Surgery Entails

The surgeon will evaluate the elbow to determine how best to repair it. He or she will also decide what kind of incision to make. One method of incision is the one we normally think of when we think of surgery—an incision made with a scalpel. In another method, a very small incision is made; it is called arthroscopic surgery. This type of surgery is so named because of the essential instrument used to perform it, called an arthroscope.

An arthroscope is a flexible fiber-optic cable about the diameter of a drinking straw, at the end of which is mounted a miniature camera. The arthroscope includes a light source and perhaps a precision tool. In arthroscopic surgery, there are usually two incisions made, one for the arthroscope and another incision for a second precise instrument. Irrigation fluid is pumped through the incision to dilate the cavity and thus create a visual space in order to perform the surgery. That fluid also anesthetizes the tissue.

The great advantage of arthroscopic surgery is how small the incisions are—usually about a half inch long or so for each incision. That translates into markedly faster recovery time, much lower risk of infection, and less trauma to the body's tissues. This is why so many professional athletes with injury to their joints get this kind of surgery. The life of their careers is very short, so they can't afford to be sidelined for very long. (And of course with such small incisions, there is far less scarring.)

Now here is where the surgeon's skills truly come into play. This is because critical decisions must be made to best repair the damage and promote healing. The typical tennis elbow surgery entails cutting away defective portions of the affected tendon and/or muscle.

Normally, the tendon is first disconnected from the bone. Then the small length of the torn, ruptured, or inflamed tendon is cut off. Lastly, the end of the tendon is reconnected to the bone. This cutting off a small portion of tendon may also have to be done at the muscle end of the tendon.

Another possible procedure that may have to be done is to cut away some portion of diseased muscle. And sometimes there is the need to shave off rough spots or protuberances from the bone so they no longer irritate the tendon or muscle.

Risks

Remember that surgery has inherent risks. Because surgery is invasive, requiring an incision however small, one of the primary risks is infection.

Being unable to fully straighten your arm months after the surgery is also a risk that must be considered. You either will or will not be able to perform that function, but no one will know that until the surgeon can see how much tendon and/or muscle must be cut away.

Of course these days, the risk associated with anesthesiology are quite minimal. However, one must very seriously consider the risk of something going wrong during the surgery. In addition to all the equipment failures that can happen, even the most established and skilled surgeon can make substantial errors.

Possible nerve damage is an additional concern. Some loss of strength in the arm may be experienced. And there may be a limitation in the arm's range of motion, particularly in completely straightening the arm.

If it looks like surgery will be part of your tennis elbow treatment, the good news is that the surgeon may be able to use lasers or robotics. The laser is used to cut away tissue, to vaporize it, and for cauterizing to stop the blood flow.

The robot can move an instrument just the tiniest fraction of an inch at one time. So it is employed by the surgeon for extremely precise movements. This is done by the robot's computer and "gears" translating the very large movements of the surgeon's arms and hands into the extremely small movements of the surgical instruments. The surgeon must tell the robot every, little, specific movement to make.

Other advantages of the capability of the robot include such things as the movement of the "hand" of the robot being capable of rotating 360°, unlike the hand of the surgeon. This makes it easier on the surgeon to perform the operation. But the substantial advantage of the robot isn't just its precision, it is that it doesn't experience the tremors that a tired surgeon can experience.

The precision of lasers and robots in surgery also results in less good tissue being cut away.

After the Surgery

The patient usually goes home the same day of the surgery. Naturally the arm must be kept dry. And according to the doctor's direction, the arm will probably need to be elevated. In fact depending upon how much tendon or muscle tissue is needed to be removed, the arm may even be put in a cast, splint, or sling. And as you can expect, pain medication may also be needed.

The splint gets removed after about a week or so. Then there will likely be some sort of rehabilitation program. This normally includes the standard physical therapy exercises mentioned at the top of this page. How well and how long your recovery lasts is also governed by how well you stick with the rehabilitation program.

How completely and how fast you recover is dependent upon a number of factors. The first is how extensive the surgery was. The more invasive the surgery and the more tissue cut, the more time to heal. But normally getting back to your daily routine can be done in 4 to 6 weeks. Getting back to intensely performing the activity that caused the injury may take up to six months. And know well that cigarette smoke adversely affects the duration of the healing process.

You will also need to consider when and how intensely to get back into the activity that caused the tennis elbow. Getting back into that activity too intensely or too soon may very well bring back the pain that signals that the tennis elbow affliction is back.

It may be best for you to wear a tennis elbow brace during the major activity, and it most certainly is worth considering modifying the equipment you are using. An example of this is a larger grip on the handle of your tennis racket, screwdriver, or hammer.