Should I have surgery to treat tennis elbow?
Introduction
This information will help you understand your choices, whether you
share in the decision-making process or rely on your doctor's
recommendation.
Key points in making your decision
Surgery is considered a last resort for treating
tennis elbow. However, if you still have elbow and
forearm pain and stiffness after 6 to 12 months of non-surgical treatment
(rest, ice, rehabilitation), you may consider surgical treatment. When making
your decision, keep in mind:
- Resting the
tendon is important. A typical case of tennis elbow
takes 6 to 12 months to heal. In some cases, the pain lasts for 2 years or
longer.1 With tendon rest and rehabilitation and
(possibly) 1 to 3 corticosteroid shots, most people with tennis elbow heal
within a year.
- Tennis elbow tendon damage worsens when you
continue painful, aggravating activity.
- There are various surgical
procedures for treating tennis elbow. However, there is no evidence to support
any one technique as being most effective.2
- Tennis elbow surgery does not guarantee a cure.
According to a few studies of people who have had tennis elbow surgery, 85% to
90% gain full relief.3
See an illustration of
tennis
elbow .
Medical Information
What is tennis elbow?
“Tennis elbow,” also called lateral epicondylitis, is a term that
describes soreness or pain on the outside (lateral) part of the elbow. Tennis
elbow symptoms occur when there is damage to the end of the
tendon that connects lower-arm and hand muscles to the
upper arm bone at the elbow.
See an illustration of
tennis
elbow.
Tennis elbow is usually caused by repeated twisting movements of
the hand, wrist, or forearm done during everyday activities, such as using a
screwdriver or scissors, gardening, and various sports.
What kind of surgery is done for tennis elbow?
Your doctor may recommend an
arthroscopic examination of your outer elbow area,
with a plan to do surgery if necessary. The most common types of tennis elbow
surgery are:
- Removal of scar tissue from the damaged
tendon area.
- Release (cutting) of the tendon that attaches the
extensor carpi radialis brevis (ECRB) muscle to the bone. The ECRB attachment
is thought to be the most common site of tennis elbow damage.4
Other types of procedures include:
- Drilling small, shallow holes in the bone to
encourage growth of new blood vessels. This helps bring blood to the area and
stimulates tendon healing.
- Repairing (reattaching) tendon tears if
it's possible to do it without overtightening the tendon.
See an illustration of
tennis
elbow.
What are the risks of tennis elbow surgery?
Risks of tennis elbow surgery include:
- Slight loss of ability to straighten the
arm.
- Elbow pain that persists or recurs.
- Infection,
blood loss, and nerve damage (which are risks in all
surgeries).
-
General or regional anesthesia risks,
such as breathing problems.
When is tennis elbow surgery appropriate?
Surgical tendon repair is a reasonable treatment when there are
large tears in the tendon from a sudden (acute) injury or if there is other
severe damage to the elbow.
Surgery may be a reasonable treatment for tennis elbow if
you:
- Have elbow pain after 6 to 12 months of
tendon rest and rehabilitation.
- Cannot do normal daily-living and
job-related activities because of elbow pain.
- Have had
corticosteroid shots and still have elbow pain.
If you need more information, see the topic
Tennis Elbow.
Your Information
Your choices are:
- Continue with tendon rest and rehabilitation
and possibly other non-surgical treatment measures.
- Have surgery to
treat tennis elbow.
The decision about whether to have surgery for tennis elbow takes
into account your personal feelings and the medical facts.
Deciding about surgery for tennis
elbow
| Reasons to have surgery for
tennis elbow | Reasons not to have surgery
for tennis elbow |
|
You have elbow and forearm pain despite 6 to 12 months of
tendon rest and rehabilitation, and:
- Your condition is definitively diagnosed
as tennis elbow.
- Your livelihood depends on eliminating tennis
elbow pain.
- Your daily living or sport activities are severely
limited by tennis elbow pain.
- You have had corticosteroid shots
that did not help.
Are there other reasons you might want to have
surgery?
|
- Your injured tendon hasn't had enough
time to heal (6 to 12 months).
- You haven't faithfully followed a
rehabilitation program for stretching and strengthening your
arm.
- Surgery doesn't offer you a guaranteed cure.
- In small studies, about 10% of people
still have pain with aggressive activity after surgery. (On the other hand, 85%
to 90% report full pain relief.)3
- Tennis
elbow surgery research isn't complete enough to recommend or discourage
particular surgical procedures.2
- Your doctor is not certain of the cause of
your symptoms.
- Your opposite elbow did not respond well to
surgery.
- You have another medical condition, such as heart, lung,
or kidney disease, that may increase the risks of surgery or
general or regional anesthesia.
Are there other reasons you might not want to have
surgery?
|
These
personal stories may help you make your
decision.
Wise Health Decision
Use this worksheet to help you make your decision. After
completing it, you should have a better idea of how you feel about surgery for
tennis elbow. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
| I have used tendon rest and rehabilitation
measures for 6 to 12 months. | Yes | No | Unsure |
| My doctor is absolutely sure that I
have tennis elbow. | Yes | No | Unsure |
| My daily-living activities are painful. | Yes | No | NA* |
| My work activities are painful. | Yes | No | NA |
| My sports activities are painful. | Yes | No | NA |
| I am concerned that the tendon is becoming more
damaged over time. | Yes | No | Unsure |
| I am willing to stick to a rehabilitation program
after surgery. | Yes | No | Unsure |
*NA = Not applicable
Use the following space to list any other important concerns you
have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a
general idea of where you stand on this decision. You may have one overriding
reason to have or not have surgery.
Check the box below that represents your overall impression about
your decision.
|
Leaning toward having surgery for tennis
elbow
| |
Leaning toward NOT having surgery for
tennis elbow
|
Return to the topic
Tennis Elbow.
References
Citations
-
Smidt N, et al. (2002). Corticosteroid injections,
physiotherapy, or a wait-and-see policy for lateral epicondylitis: A randomised
controlled trial. Lancet, 359(9307):
657–662.
-
Buchbinder R, et al. (2006). Surgery for lateral elbow
pain. Cochrane Database of Systematic Reviews (1).
Oxford: Update Software.
-
Gabel GT, Morrey BF (1998). Tennis elbow. AAOS Instructional Course Lectures, 47: 165–172.
-
Putnam MD, Cohen M (1999). Painful conditions around
the elbow. Orthopedic Clinics of North America, 30(4):
109–118.
Credits
| Author | Monica Rhodes |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Denele Ivins |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Martin Gabica, MD
- Family Medicine |
| Specialist Medical Reviewer | David Pichora, MD, FRCSC
- Orthopedic Surgery |
| Last Updated | February 14, 2007 |
|
