Fortunately tennis elbow surgical treatment is not often needed. Tennis elbow symptoms usually can be treated nonoperatively. However, when nonsurgical treatment fails, tennis elbow surgical treatment will be required to provide relief.
As mentioned in a prior post, the primary issue in tennis elbow is a local area of tendon degeneration. This may occur in one or more tendons that originate from the bony prominence on the outside of your elbow. This tendon breakdown nearly always heals with time. However, in about 5% of people with tennis elbow, the damage won’t heal even after waiting a year. In others, the pain or resultant disability is so great that waiting long enough for the tendon to heal, is not an option. In both of these situations, surgery may be the best treatment choice.
When tennis elbow surgical treatment is needed, there are several options available. All of the surgical treatments focus on removing the damaged tendon tissue (Debridement). They all are performed as an outpatient procedure. All require anesthesia so that no pain is experienced while the procedure is being performed. The primary difference in the procedures comes from how the debridement is accomplished. No matter the procedure, the postoperative course requires some short-term protection of the elbow, a reduction of strenuous activities for a period of time, postoperative physical therapy and several months of recovery. However, the amount needed for this postoperative care tends to differ depending on the surgical technique used. Fortunately, the results of all the options are universally good.
Let’s take a look at the tennis elbow surgical treatment options.
Tennis Elbow Surgical Treatment
1. Mini-Open Debridement
By making a small incision on the outer side of your elbow, the surgeon can move the overlying healthy tissues and expose the damaged tissue. Under direct visualization, all the injured tendon tissue can easily be seen and removed. Sometimes this may be accompanied by a roughening or drilling of the adjacent bone in order to bring healing blood to the area.
Although small, this incision is bigger than that used in the other techniques. This, along with the need to move healthy tissue in order to visualize the injured tissue, often results in a longer recovery than the other two procedures to be discussed. Some argue that this is an acceptable trade-off so that the anatomy and involved tissue can be visualized clearly.
2. Arthroscopic Debridement
On another page on this site, I have discussed arthroscopy in more detail. Arthroscopy uses a small fiberoptic camera and other small instruments through tiny incisions to evaluate and treat problems around a joint. During this procedure, the arthroscope is inserted into the elbow. Once adequate visualization of the joint is obtained and the area of the degenerated tendon is located, a small shaving device is used to remove the damaged tendon.
The primary advantages of arthroscopic treatment is that only small incisions are needed, that healthy tissue does not need to be moved to expose the damaged tissue, and any additional issues that may exist within the elbow joint can be identified and addressed during the same procedure. However, there is a “cost” for using arthroscopy. In order to perform this procedure, incisions on both sides of the elbow are required. Additionally, the joint needs to be filled with fluid in order to distend it and enable visualization of the joint’s structures. This fluid and the multiple incisions, although relatively small, lead to more swelling, and perhaps, more discomfort early after surgery. Furthermore, the results of an arthroscopic debridement have not been shown to be better than an open debridement for mostly all clinically relevant outcomes.
3. Percutaneous Debridement
This method requires ultrasound for visualization. A unique pen-sized technology that uses ultrasonic energy at the appropriate wavelength so that the device will only remove the involved tissue while leaving the healthy tendon alone is also used. Because of the small size of this device, only one tiny, several millimeter incision is needed. This dramatically reduces surgical time, tissue trauma, postoperative pain and swelling. It also significantly reduces healing time.
The following video shows an animation of the ultrasonic device removing degenerated tissue.
Since ultrasound, with its somewhat grainy picture, is used to visualize the damaged tissue, one could worry that not all the involved tissue will be seen, and therefore not fully removed. Fortunately, the results of this technique seem to be equally as good as those using an “open” or arthroscopic exposure. So this concern, although understandable, does not seem to be justified. As a result, when appropriate, this is my preferred surgical technique.
Fortunately tennis elbow usually resolves without the need for surgery. However, if it doesn’t or your symptoms are so severe that waiting longer is not possible, there are some very good surgical options. So if you are suffering from this problem and not getting better, it may be time to visit with your sports medicine doctor to see if surgery can help.