Tennis Elbow Lateral Epicondylitis Therapy – Elbow Surgery

Tennis Elbow Lateral Epicondylitis Therapy

Who Needs Tennis Elbow Surgery?

Tennis Elbow Surgery is considered for patients who don’t respond to 6 months of conservative therapy including corticosteroid injections.

A study published in 2008 which looked at 45 Clinical Studies into surgical treatment provides the following facts about Tennis Elbow Surgery:

  • most patients were between 30 and 50 years old
  • no difference between male and female
  • an average of 74% had their dominant arm affected
  • patients had symptoms an average of 19 months before surgery

Several elbow surgery procedures and their variations have been developed for the treatment of tennis elbow over the years. Most elbow surgery procedures involve removal of the scarred / degenerated tissue of the extensor carpi radialis brevis (ECRB) muscle with or without some form of drilling of the lateral epicondyle.


Tennis Elbow Lateral Epicondylitis Therapy – 3 Types of Elbow Surgery

Open Release

Elbow Surgery


In the classic open-release Tennis Elbow Surgery procedure for lateral epicondylitis a 3-cm long cut is made in the skin over the lateral epicondyle. An incision is made through the extensor aponeurosis – a layer of fibrous tissue which surrounds muscles. The extensor carpi radialis longus (ECRL) muscle is pulled out the way, exposing the degenerative tendon of the ECRB. All damaged tissue is cut away. The lateral epicondyle is decorticated – this means that the outer hard surface of the bone has holes cut into it to expose the spongy bone underneath. This produces some local bleeding which improves healing. The ECRL is stitched to the extensor aponeurosis to provide extra strength around the ECRB tendon and help repair the defect caused by removing the damaged tissue.
Picture with thanks.




Percutaneous Release

There is a small (0.5cm) cut made in the skin over the lateral epicondyle and through this cut the common extensor origin is released (cut away) from the bone. This effectively allows a lengthening of the tendon because the surgeon produces a gap which bleeds and heals. The healed tissue which fills the gap makes the tendon a few millimetres longer and this releases the stress on the ECRB.
Some surgeons carry out this procedure using a large hypodermic needle to cut through the common extensor origin. With this procedure there is no cut in the skin only a small injection hole.


Arthroscopic Release

TE arthroscopy


With elbow arthroscopy, the joint capsule and undersurface of the ECRB tendon are easily seen and evaluated through the camera. The ECRB tendon is then followed to its origin on the lateral epicondyle. The release of the ECRB tendon is begun at the site of pathology and is continued back to its origin on the lateral epicondyle. After release the lateral epicondyle bone is decorticated to encourage bleeding and release of factors which stimulate repair.





Results After Elbow Surgery

The study published in 2008 found that :-
The OPEN approach had
a reported mean failure rate of 11.4%,
with a reported mean complication rate of 10.6%.
Commonly reported complications were wound haematoma, wound infection/abscess, scar disturbance, chronic pain, stiffness and neurological problems.
The mean time to return to work (pre-injury) was 6.6 weeks.

The PERCUTANEOUS approach
reported a mean failure rate of 8.7%,
with a reported complication rate of 6.3%.
There were two reported wound haematomas.
Time to pain relief of 8.5 weeks -no return to work time reported.

The ENDOSCOPIC approach had
a reported average failure rate of 8.3%,
with no reported complications.
The average time to return to work was 9.6 days.

In reading these results it should be remembered that this study looked a research papers going back to 1953 when variations of the open approach were the only ones being carried out – this may account for the slightly higher failure rates reported for this category.

The significantly shorter return to work time between that open and arthroscopic approach in elbow surgery is important though.

Conclusion

I think it is best to quote Salil Karkhanis, Andrew Frost, and Nicola Maffulli the authors of the paper “There is insufficient evidence to support the use of one operative procedure for TE over another” and just leave it up to you and your specialist to decide what type of Elbow Surgery you require.


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Ian Constable (73 Posts)


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