Assistance
Search

Pros & Cons to Tennis Elbow Surgery

INTRODUCTION: WHAT IS TENNIS ELBOW?

Tennis elbow, also known as ‘lateral epicondylitis’, is inflammation around the joint, resulting in pain in the outside of the elbow, particularly with movement. Tennis elbow does not just affect tennis players; it is caused by repetitive use or overuse of the extension muscles that attach around the elbow and is actually most common in women aged 40-60 years. It is similar to ‘Golfer’s elbow’, which causes similar symptoms around the inside of the elbow and is caused by repetitive use of the flexion muscles that attach around the elbow.

  

I HAVE TENNIS ELBOW – DO I NEED SURGERY?

Tennis elbow is known as a ‘self-limiting’ condition, meaning that it often resolves on its own with supportive treatment (i.e. pain relief and physiotherapy). In 90% of cases, episodes resolve within 1 year. If the symptoms are not resolved after 1 year of supportive management, further options, including surgery, can be explored. Tennis elbow can recur in 8.5% of cases; these cases are also often suitable for surgical treatment.

 

At this stage, whilst surgery is a viable option, there are several alternatives, including continued physiotherapy, steroid injections, alternative injections (see Table 1) and acupuncture for those who wish to avoid surgery.

Table 1 – Effects of alternative injection therapies following failure of supportive treatments

INJECTION TYPE

EFFECT

Steroid

Steroid injections are often used in managing arthritis, and can provide short-term symptom relief. However, there have been some links to an increased rate of recurrence.

PRP (Platelet-Rich Plasma)

These contain blood products, and have been shown to be a viable alternative to surgery in tricky-to-treat tennis elbow.

Botulinum

This will temporarily paralyse the affected muscles, followed gradual re-loading of the joint to restore function.

Hyaluronan gel

Also used in arthritis, some early research has shown that these compounds can assist in tendon healing.

 

 

 

 

 

 

 

 

 

 

 

 

HOW DOES SURGERY HELP?

The general aim of surgical treatment is to remove the damaged/inflamed muscle and then reattach the healthy part of the muscle. This is most commonly done using an open surgery’ approach, but can also be done arthroscopically (using very small incisions, a camera and small instruments). Alternatively, ‘percutaneous release’ can be done under a local anaesthetic with a small incision through the skin and tendons. Each of these approaches can be done as a day case, and does not require an overnight stay. They can be done under a general anaesthetic or with a local anaesthetic and sedation.

When thinking about which type of surgery could be most effective for you, it is important to consider the level of anaesthetic as well. General anaesthetic carries several risks with it, and may not be suitable for everyone; you should discuss this with your doctor before undergoing any surgical procedure. In terms of the three different procedures themselves, some studies suggest that success rate is more dependent on the skills and experience of the individual surgeon rather than the approach used. Some more recent reviews of surgical outcomes suggest that the open and arthroscopic approaches result in better short-term function than the percutaneous release, but there was no overall difference in returning to normal function and work in the long term. Overall, it is best to discuss all the available options with your doctor to see which procedure is the most suitable for you.

Following a surgical procedure for tennis elbow, it is important to engage in follow-up elbow rehabilitation and physiotherapy which aims to gradually reload the joint and return to normal function. This usually takes 4-6 months and is successful in 80-90% of cases.

 

WHAT ARE THE RISKS?

The risks for tennis elbow surgery can be split into two main categories: surgical risks (complications that may occur in any surgical procedure) and procedure-specific complications.

 

Surgical risks
  • Reaction to anaesthetic/medicines
  • Infection
  • Bleeding or blood clots
Procedure-related risks
  • Relapse of symptoms/need for further surgery
  • Loss of strength or range of movement
  • Injury to nerves or blood vessels around the operation site
  • Need for longer-term physiotherapy
  • Post-operative pain
  • Scarring (more so with the open-surgery approach)

 

IN SUMMARY

Surgery is really only useful for tennis elbow if you are still having symptoms after a year of effective pain relief and physiotherapy, which applies to around 10% of patients. Of those 10%, surgery is an effective treatment for 80-90% of patients. There are various options within surgical interventions, and it is best to discuss these with your doctor. The main risks for tennis-elbow surgery are those associated with surgery in general, and sometimes reduced function following the procedure. There are multiple treatments available as alternatives to surgery; if you would like to know more, please discuss these with your doctor.

 
Date: 17/09/2018
0mPkg4