Introduction

Tennis elbow, clinically known as lateral epicondylitis, is a common overuse injury characterized by inflammation and microtears of the tendons that attach to the lateral epicondyle of the elbow. It is often associated with activities involving repetitive forearm muscle contractions, such as tennis, painting, hammering, typing, gardening, and playing musical instruments. This article outlines the diagnosis, treatment options, and potential risks and complications associated with tennis elbow surgery.

Elbow Anatomy

The elbow is a complex joint composed of three bones: the humerus (upper arm bone) and the radius and ulna (forearm bones). The lateral epicondyle is a bony prominence on the outer side of the humerus where tendons and muscles responsible for extending the fingers and wrist attach.

Signs and Symptoms of Tennis Elbow

Tennis elbow typically presents with the following symptoms:

• Gradually worsening elbow pain.
• Pain radiating from the outside of the elbow to the forearm and wrist, especially when grasping objects.
• Weak grip strength.
• Painful grip.
• Aggravation of pain when bending the wrist backward.

Causes of Tennis Elbow

Tennis elbow is primarily attributed to overuse of forearm muscles but can also result from direct trauma, such as falls, car accidents, or workplace injuries. While tennis players are often associated with this condition, it can affect individuals engaged in various repetitive tasks, including painting, hammering, typing, raking, weaving, gardening, lifting heavy objects, and playing musical instruments.

Diagnosis of Tennis Elbow

To diagnose tennis elbow, a healthcare provider will:

• Review the patient’s medical history.
• Conduct a thorough physical examination.
• Utilize diagnostic imaging tools such as X-rays, MRI scans, or electromyograms (EMG) to assess any nerve compression.
• Treatment of Tennis Elbow

Initially, conservative treatment options are recommended to alleviate tennis elbow symptoms, including:

• Rest and avoiding activities that exacerbate the condition.
• The use of splints or braces to reduce stress on the affected tissues.
• Application of ice packs to reduce swelling.
• Avoidance of activities that place strain on the tendons.
• Prescription of anti-inflammatory medications or steroid injections for pain and swelling management.
• Occupational therapy to facilitate strengthening and stretching exercises once symptoms subside.
• Pulsed ultrasound to enhance blood flow and promote healing in the affected tendons.
• Lateral Epicondyle Release Surgery

If conservative treatments fail to provide relief, and symptoms persist for 6 to 12 months, surgical intervention may be recommended. Lateral epicondyle release surgery, also known as tennis elbow surgery, is a viable option. Surgery is considered a last resort, with only 1 in 10 patients necessitating it. The procedure has a success rate of 85-95%.

The surgical aim is to remove the diseased tissue surrounding the outer elbow, improve blood circulation in the area, and alleviate symptoms. Surgeons may choose either the traditional or endoscopic approach:

Traditional Surgery: This method involves a larger incision (up to 2 inches) in the elbow area.

Endoscopic Surgery: This minimally invasive approach employs one or two small (½ inch) incisions near the lateral epicondyle. An endoscope equipped with a camera allows surgeons to visualize internal structures, while another incision is used to insert surgical instruments. The procedure involves assessing the extensor tendon, trimming or releasing it, and reattaching it to the bone, along with removing any scar tissue or bone spurs.

Surgery is typically performed as outpatient day surgery under regional or general anesthesia. The endoscopic approach is less invasive, resulting in smaller scars that are often barely noticeable.

Risks and Complications of Tennis Elbow Surgery 

Like any major surgery, tennis elbow surgery can involve certain risks and complications, including:

• Allergic reactions to medications.
• Blood loss.
• Cardiovascular events (e.g., heart attack, stroke).
• Kidney failure, pneumonia, or bladder infection.
• Infection at the surgical site.
• Nerve damage, particularly radial nerve damage, leads to numbness, tingling, burning, or loss of sensation in the back of the hand and forearm.
• Wrist weakness with extension.
• The possibility of symptom recurrence or inadequate relief.

In conclusion, tennis elbow surgery is a last resort option for those with persistent symptoms after conservative treatments. Patients should carefully consider the potential risks and benefits of this procedure in consultation with their healthcare provider.