Tennis elbow release can be performed by either open or keyhole (arthroscopic) techniques. Both involve release of the degenerate ECRB tendon origin and are performed as a day-case procedures. Both techniques achieve comparable outcomes, with approximately 80% of patients better by six months. The arthroscopic technique has been shown to enjoy a swifter recovery; it also offers the ability to address any co-existing internal problems in the elbow.
The open technique requires a 2-3cm incision over the outer prominence of your elbow. The superficial muscles are elevated to expose the degenerate ECRB tendon beneath. The degenerate tissue of the ECRB tendon is excised.
In the keyhole technique, two 5mm portals allow a surgical telescope and instruments to be passed carefully into your elbow. Your elbow joint is inspected and the ECRB tendon, which lies just outside your joint capsule is then released from the inside. Any other problems discovered within your elbow (e.g. plica or cartilage defect) can normally be addressed at the same time.
Arthroscopic view of the elbow joint with a needle coming in through the lateral capsule. The ball on the right is the capitellum of the humerus. The concave bone on the left is the radial head. The lateral capsule is windowed to allow resection of the degenerate ECRB tendon which lies just beyond the capsule.
Golfers’ elbow release is performed via open technique. A 7 cm incision is centred over the medial epicondyle of your elbow and your ulna nerve is protected. The tendon origin is inspected for degenerate tissue, which is excised. The tendon origin is repaired to the bone. If you have had concurrent symptoms of an entrapped or irritable ulna nerve, then your ulna nerve will be released at the same time.
Of those who need surgery, 80% will be happy with their outcome by 6 months, but a few patients will continue to experience pain during certain activities. In general, golfers’ elbow tends to be a bit more resistant to treatment than tennis elbow.
Tennis elbow and golfers’ elbow surgery has a low complication rate.
Infection is rare. The risk of nerve injury is slightly higher with arthroscopic techniques, but it is still low and even if a nerve were injured, it would usually recover spontaneously (e.g. nerve bruised rather than cut). Stiffness can occasionally follow any surgery around the elbow, but it is rarely significantly troubling. A minority of patients will continue to suffer with pain around their elbow.
This is a day-case operation performed under general anaesthesia. Please begin your painkillers as soon as you get home and take them regularly for the first fe days. Please remove your bulky bandage after 3 days, but keep your sticky dressings dry and clean for two weeks. You will be seen at two weeks and any suture ends will be trimmed. You will need to do eccentric stretching and strengthening exercises as part of your rehabilitation. Your physiotherapist will guide you on these.
Patients vary in their recovery after this surgery, but for guidance, you may expect to return to:
Desk-based work approx. 3-6 weeks
Driving approx. 3-6 weeks
Return to heavy duties approx. 8-16 weeks
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.