3. Surgery for tennis elbow
When is tennis elbow surgery indicated?
Most cases of tennis elbow are self-limiting and do not require an operation. However where intrusive symptoms have been present for more than six months and have failed to respond to non-operative treatment, then surgery in the form of a tennis elbow release may be considered.
What does a tennis elbow release involve?
Tennis elbow release is not a major operation and can usually be performed as a day-case, but it does require a general anaesthetic. The actual surgery takes about 25 minutes.
The operation is performed through a short incision on the outer side of the elbow. The degenerate part of the tendon is excised, the underlying bone is drilled to stimulate healing, and the adjacent tendon is repaired over the top. The skin is closed with a dissolvable stitch and a padded bandage is applied.
Studies have shown that this operation is successful in over 80% of cases.
What happens after surgery?
Once you are awake you will be transferred back to the ward. You can usually go home the same day once the anaesthetic has fully worn off and you are eating and drinking.
Local anaesthetic is usually injected around the wound at the end of the operation and this should minimise post-operative pain for the first six to eight hours. It is advisable to start taking pain-killers before this local anaesthetic wears off.
The elbow can be used straight away for light activities, but it is essential to avoid anything heavy or repetitive for 12 weeks afterwards in order to allow the tendon to heal. The padded bandage is left in place for two weeks to provide some protection and support whilst allowing movement.
Most people notice a significant improvement by six weeks, though full recovery can take three to six months.
When can I go back to work?
This depends on the nature of your job. If it is sedentary then you should be able to go back after a couple of weeks, though you should avoid using a computer for long periods as this is likely to aggravate the tendon as it tries to heal.
You should avoid more physical work for at least 12 weeks, though it may take longer to return to very heavy work. It is important to return to heavier activities in a gradual fashion.
When can I drive?
You shouldn’t drive for the first two weeks while your arm is in the padded bandage. After that you should be able to drive short distances, though bear in mind that you must be able to control the vehicle safely and change gear.
When can I return to sport?
I would advise against any sport for the first few weeks after surgery. Gentle running or cycling using a static reclined bike can begin at three to four weeks provided it doesn’t aggravate the elbow. Gentle strengthening can start around the eight week mark though it is important that this is done in a gradual manner and under the supervision of a physiotherapist.
Contact sports, racquet sports, or any other sports which may place a sudden strain on the elbow should be avoided until at least three or four months, though the exact timing depends on the speed of your recovery and should be discussed with your surgeon. The return should be gradual and only after an appropriate conditioning program under the supervision of a physiotherapist. It is also a good idea to protect the elbow with a tennis elbow clasp, at least initially.
Finally before returning to racquet sports, and tennis in particular, it is vital that you address any factors which may have predisposed you to tennis elbow in the first place. This includes your racquet, your strings, and your technique. This will be discussed in my next tennis elbow article.
What are the risks of tennis elbow release?
As with all operations there is a small risk of infection, nerve damage or bleeding. Other risks include stiffness and wound sensitivity.
Finally there is a risk of some residual symptoms.