Patients › Elbow
Tennis Elbow Release
Tennis elbow release surgery — for persistent pain despite physiotherapy and other conservative treatments.
Why this operation has been suggested¶
This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. Tennis elbow release is a procedure to relieve pain and improve function in your elbow. We typically offer this to you only after non-operative options have not given enough improvement. Most people recover within 12 to 18 months without surgery. About 90% of people with untreated tennis elbow achieve symptom resolution by 1 year. Symptoms have a steady half-life of three to four months. Longer duration does not mean a poorer prognosis.
We consider surgery when conservative care fails and your pain persists. For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates. This operation aims to reduce pain and restore your ability to use your arm. We recommend it when the benefits outweigh the natural history of the condition. Your recovery depends on your specific symptoms and response to prior treatments.
Before the operation¶
Your surgeon will arrange any necessary tests, such as X-rays or blood work, to ensure you are fit for surgery. Please fast from midnight the night before your procedure. Stop taking blood-thinning medications only after your surgeon gives you specific instructions. Arrange for someone to drive you home and stay with you for the first night. Wear loose, comfortable clothing to your appointment. Bring a complete list of all current medications and supplements. This open procedure uses a single incision over the elbow. We will guide you through every step to keep you safe and informed.
On the day¶
This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.
You will arrive at the hospital for admission. You will meet your anaesthetist to discuss your care. Your surgeon performs this operation as an open approach with a single conventional incision over the operative site. You will then go to the operating theatre. After the procedure, you will wake up in recovery. Our team will monitor you closely while you recover from the anaesthetic.
What the operation involves¶
Your surgeon performs this procedure through a single conventional incision over the outer part of your elbow. This open approach allows direct access to the affected tendon without the need for multiple small keyhole cuts or cameras.
During the surgery, your surgeon carefully identifies the extensor carpi radialis brevis tendon, which is the tissue causing your pain. Using precise instruments, the surgeon removes the damaged and degenerative portion of this tendon attachment. The surgeon also cleans and prepares the underlying bone surface, known as the lateral epicondyle, to promote healthy healing. This process releases the tension on the tendon and removes the source of irritation.
Once the damaged tissue is removed and the bone is prepared, your surgeon closes the incision using sutures or staples. A sterile dressing is applied to protect the site. The entire procedure is focused on correcting the structural issue in your elbow to relieve pain and restore function.
After the operation¶
You will wake up in the recovery ward with your arm in a sling and a soft dressing. We manage pain with standard medication. This is usually a day case, so you can expect to go home the same day, although occasionally patients stay overnight. Someone must stay with you for the first 24 hours. Your surgeon performs this operation as an open approach with a single conventional incision over the operative site. You can usually return to driving within two to three weeks, once pain has settled enough to hold the wheel and react quickly. Do not drive while your arm is in a sling. See Driving after upper-limb surgery.
Recovery¶
You will notice some swelling and stiffness in the early days. This is normal. We keep discomfort manageable with simple pain relief and rest. Your arm may feel heavy or tender around the incision site. This tends to ease as the initial swelling settles. We advise keeping the area elevated when possible to help reduce fluid buildup.
You will have a soft bandage over the surgical site, with a sling for comfort for the first week or so; the elbow is not immobilised in a cast or splint. We do not recommend driving while your arm is in a sling. You can usually return to driving within two to three weeks, once your pain has settled enough to hold the wheel and react quickly. For more details, see Driving after upper-limb surgery.
Your rehabilitation is guided by our team. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. She will teach you gentle movements to restore range of motion. You will start with light activities at home, such as gripping soft objects. As movement returns, you will gradually increase strength. We focus on the upper segments in addition to the elbow to ensure full recovery.
Your timeline may differ; your surgeon and physio will guide you. We monitor your progress closely to ensure you are healing well. You will know you are improving when daily tasks become easier and pain decreases. Trust the process and follow our advice for the best outcome.
What can go wrong¶
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Persistent symptoms are a possibility. You might notice that the pain on the outside of your elbow does not go away or returns after you thought it had healed. This can feel like a dull ache or sharp pain when you grip things. If your symptoms do not improve, contact the clinic to discuss your progress.
Infection is a risk with any surgery. You may see redness spreading out from the wound site. The area might feel hot to the touch or look swollen. You could also develop a fever. If you notice these signs, call the clinic immediately or go to the emergency department.
A slight limitation in your range of motion can occur. You might find it harder to fully straighten or bend your elbow than before. This can feel like a tightness or a physical block when you move your arm. Bring this up at your next review so we can adjust your rehabilitation plan.
Heterotopic ossification is a rare condition where bone forms in the soft tissues around the joint. You might feel a hard lump under the skin near the elbow. This can restrict movement and cause discomfort. Report any new lumps or significant changes in mobility to your surgeon.
Revision surgery is rarely needed. The need for further operation is very low. However, having three or more injections before your procedure increases this risk. If you have had multiple injections, be aware that your surgeon may discuss this with you during your consultation.
The complications table on this page lists typical rates if you want the specifics.
When to call us¶
Call us if you have fever, increasing wound redness or discharge, sudden severe pain, calf swelling or shortness of breath, loss of sensation, or inability to move the limb. Go to emergency if these symptoms are severe. We want to ensure your recovery stays on track. Contact our clinic promptly so we can assess your needs and provide the right support for your healing process.
Evidence & references
Anatomy & Pathophysiology¶
- The pathologic tissue in tennis elbow involves the undersurface of the extensor carpi radialis brevis tendon [1].
- The origin of the extensor carpi radialis brevis is visualized during arthroscopic tennis elbow release [1].
- Decortication of the lateral epicondyle and lateral epicondylar ridge is performed to address pathologic tendinous attachment [1].
- Undersurface tears of the extensor carpi radialis brevis are a finding in tennis elbow release procedures [1].
- Medial capsular injury may occur and allow excessive fluid extravasation during arthroscopic elbow procedures [1].
- A 30-degree arthroscope is adequate to view around the corner for most of the arthroscopic tennis elbow release procedure [1].
- A 70-degree arthroscope may be required in rare instances during arthroscopic tennis elbow release [1].
- The proximal medial or superomedial portal is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [1].
- The trocar and sheath for the proximal medial or superomedial portal are introduced anterior to the intermuscular septum [1].
- The trocar is directed toward the radial head while maintaining contact with the anterior aspect of the humerus [1].
- The superolateral portal is established with an 18-gauge needle through the lesion [1].
- Debridement of the capsule and pathologic tendinous attachment of the extensor carpi radialis brevis is performed using a curet and motorized shaver [1].
- Decortication of the lateral epicondyle can be done with an arthroscopic burr, handheld instruments, or electrocautery [1].
Treatment¶
- Arthroscopic tennis elbow release is described as technique 52.39 [1].
- The patient is placed prone on the operating table after intubation [1].
- Two rolled towels are placed longitudinally under the patient's thorax [1].
- All bony prominences are padded well [1].
- The affected extremity is positioned with the ipsilateral shoulder abducted to 90 degrees [1].
- The arm is supported with a precut foam holder [1].
- Anatomic landmarks and portal sites are marked prior to the procedure [1].
- The joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [1].
- The proximal medial or superomedial portal is established approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [1].
- The trocar and sheath are introduced anterior to the intermuscular septum [1].
- Contact with the anterior aspect of the humerus is maintained at all times as the trocar is directed toward the radial head [1].
- A 2.7-mm, 30-degree arthroscope is inserted into the joint to perform the diagnostic portion of the procedure [1].
- The superolateral portal is established with an 18-gauge needle through the lesion after pathologic tissue is identified [1].
- A full-radius resector is used to excise the capsule to identify the undersurface of the extensor carpi radialis brevis tendon [1].
- The origin of the extensor carpi radialis brevis is viewed [1].
- A curet and motorized shaver are used to debride the capsule and the pathologic tendinous attachment of the extensor carpi radialis brevis [1].
- The lateral epicondyle is decorticated [1].
- Decortication of the lateral epicondyle and lateral epicondylar ridge can be performed with an arthroscopic burr, handheld instruments, or electrocautery [1].
- A 30-degree arthroscope is adequate to view around the corner for most of the procedure [1].
- A 70-degree arthroscope may be required in rare instances [1].
- Limited internal fixation can be accomplished with cannulated screws when medial capsular injury has not occurred [1].
- The benefit of arthroscopy is outweighed by associated risks in more extensive fractures involving significant soft-tissue injuries [1].
- One should be fully prepared to abort the procedure when visualization is poor or fluid extravasation is significant [1].
References¶
[1] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE.