When does ‘tennis elbow’ mean surgery?

Lateral epicondylitis more popularly known as "Tennis Elbow" affects approximately 1-3% of population annually. It may occur in non-athletes and athletes alike. Interestingly enough, only about 5% of patients with tennis elbow are in fact tennis players.

Treatment for this condition is for most part conservative. This means either local injections of small doses of steroid around the extensor tendon origin and lateral epicondyle (a portion of the elbow bone), physical therapy, bracing, and observation.

Other conservative treatment options include injections of PRP (platelet rich plasma). Platelet rich plasma is a centrifuged product of the patient's own blood which is injected around the tendon injury (tendinitis, tendinosis). This method is thought to stimulate a supra-physiologic release of growth factors in an attempt to jump start healing in chronic injuries. This treatment modality is fairly expensive and the data on its efficacy is inconclusive.

About 5% of patients will end up getting surgery to treat lateral epicondylitis. Usually it is in cases of failure of conservative management of tennis elbow from 6 months to a year.

Prior to deciding whether surgery is the best treatment option, elbow X rays and an MRI will be ordered to confirm the diagnosis. MRI will best visualize the origin of the common extensor tendon and will be able to determine if there are any significant tears or inflammation around the tendon with sensitivity of anywhere from 90-100%. MRI studies will also be able to demonstrate other important structures in the elbow and rule out their involvement.

If the decision for surgery is made, there are several options of how the surgery is performed:

Lateral epicondylitis release is done as an "outpatient". Meaning the patients don't need to spend the night in the hospital. It is usually performed under general anesthesia or an arm block (where a local anesthetic is used to numb up the surgical field).

The most common surgery performed is open release of the common extensor origin. This is done through about a 5 cm incision on the lateral portion of the elbow to free up the common extensor tendon.

Several other open approach surgeries are offered depending on the severity of tendinitis or presence of an actual tear to the common extensor origin including lengthening and common extensor reattachment with debridement.

Common extensor tendon release surgery can also be performed via elbow arthroscopy which is several very small incisions less than 1 cm in length each. Use of video arthroscopic equipment is needed in this case. This particular approach may increase the incidence of injury to the radial nerve which runs on the outer portion of the elbow. The upside to an arthroscopic common extensor origin release is decreased recovery time and faster healing.

Results of the lateral epicondylitis release are generally good and lead to improvement in anywhere from 80-94% of patients.

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