Epicondylitis Surgery

For patients who are truly disabled by Epicondylitis (many experience difficulty with such simple daily functions as lifting a cup of coffee, writing, or shaking hands) and have not benefited from other treatment modalities, surgery may be advised. Two surgical techniques are available – open surgery and arthroscopy.

Open Surgery for Epicondylitis

Open surgery requires a larger incision and affords a number of options. A little chip of bone can be removed to purportedly increase blood flow into the area and thereby promote healing and reduce pain. Alternatively, a small portion of the tendon can be released by severing its connection to the bone. This leaves most of the tendon still attached to the bone and functional so that there is virtually no loss of mechanical strength. The tendon also can be repaired by debriding, i.e., cutting away the unhealthy portion of the tendon and reattaching the healthy portion to the bone.

Artroscopic Surgery for Epicondylitis

Arthroscopic surgery utilizes two small incisions, one on the medial side and one on the lateral side of the elbow. The surgeon uses a fiberoptic instrument that makes it possible to see into the joint through the small incisions during surgery, which involves cleaning out all of the torn-off tissue, in essence, releasing a small portion of the tendon. In general, no bone is removed, however some surgeons roughen the surface with a motorized tool to generate a more generous blood flow to that region.

Epicondylitis Surgery Follow up

Following surgery, patients who have arthroscopic treatment are not splinted, but simply have the elbow covered and wear a sling. They may begin gentle stretching exercises of the wrist and elbow in the immediate post-operative period as tolerated. Supervised physical therapy is initiated if the patient is failing to regain adequate motion or strength in the month following treatment.

For patients who have the open debridement, the wrist is usually splinted in extension for three to six weeks to allow healing of the repaired and reattached tendon origin. The patient then begins gentle stretching and strengthening with supervision of a physical therapist or hand therapist.

Although pain relief is usually significant, the pain of Epicondylitis can recur. Surgical patients are advised to guard against any old habits that may have caused or exacerbated their condition. In the case of tennis players, the orthopaedic surgeon may suggest exercises to improve shoulder strength and foot speed before returning to the sport, as well as consultation with a tennis pro. Because tennis elbow can be bilateral—up to 20% of those Dr. Hotchkiss sees have some evidence of the condition in both arms—caution should be exercised to protect the untreated elbow.