This operation is performed for a condition called tennis elbow. The aim of the operation is to remove the degenerate tendon on the outer aspect of the elbow to promote a healing response and the regeneration of normal tendon tissue.
Symptoms from tennis elbow vary significantly between patients. Some patients may have discomfort to the outer aspect of the elbow after strenuous exercise whereas others will have severe pain that prevents them from doing their normal activities. The severity and duration of your symptoms will dictate whether you should proceed to surgery.
It is likely that you have already tried non-surgical treatments for your tennis elbow such as pain killers, activity modification, physiotherapy and injections. The next logical step would be to consider surgery. A tennis elbow release has a good chance of improving your symptoms although it is unlikely to give a quick recovery. This is because the surgery can only try to promote a healing response in the diseased tendon and so relies on your biology to provide this, which takes time.
Description of surgery
The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital. You will also need to have a responsible adult at home with you on the night of the operation.
The operation is performed through a 4cm incision on the outside of your elbow. The surgeon will then identify the tendons and cut out the portion of the tendon that is diseased. The bony attachment of the tendon is rasped to help provide blood with essential healing enzymes to the area. The tendon is then stitched closed. The operation itself takes about 30 minutes.
The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.
Your pain can be well controlled with local anaesthetic given during the operation.
What are the risks?
All operations involve an element of risk. The risks for this particular operation are small but it is important that you are aware of them.
The risk of infection is very small and is thought to be about 0.5%. Most infections will settle simply with antibiotics.
Damage to nerves and blood vessels around the elbow can occur but this is rare.
The main risk is that your symptoms do not fully resolve. Surgery seems to be effective in approximately 80% of patients.
Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up. This can last up to 12 hours but the elbow may be sore after it wears off. You will be given a combination of pain killers to go home with. It is important that you take regular pain relief so that you can start moving your arm early.
You will wake up with your arm in a bulky bandage. This can be removed 2 days following the surgery and is used to help with swelling. There will be dressings applied to the wound under these bandages. These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.
The dressings are splash proof but not waterproof and so you should avoid getting them wet.
The wound is closed using dissolvable stitches. The stitches do not need to be removed but there may be loops at each end of the wound that can be trimmed. The nurses will arrange this to be done at your local GP practice before you are discharged.
You may be given a sling but this is only for comfort. You can get rid of the sling as soon as you feel comfortable.
The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation. They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation. Physiotherapy can be arranged local to you.
You can drive when you feel you are safe to drive. This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road. This will vary between patients but normally takes about a week.
Return to work
This depends on what your job is. You should be able to return to a “desk job” within a few weeks of your surgery. If you have a more manual job it can take up to 6 weeks before you feel ready to return to work. Please discuss this further with your surgeon or physiotherapist if you feel unsure. A sick note can be given to you at the time of your surgery if required. Please ask the nurses on the ward if you need one.
What to expect
Recovery following surgery can be quite variable. Your symptoms should be approximately 80% better by 3 months with the majority fully recovered by 6 months. It can, however, take up to a year for some patients to fully improve.
Matthew Hall BSc(Hons), MBChB, FRCS(Trauma & Orthopaedics)