Tennis Elbow Surgery in West Palm Beach, Jupiter & Palm Beach Gardens, FL
Persistent tennis elbow can cause pain on the outside of the elbow, weakness with gripping, and difficulty performing work, sports, or everyday activities. Most cases can be managed without surgery, but patients with chronic symptoms that do not improve with appropriate nonsurgical treatment may be considered for surgical treatment. Dr. Brian W. Hill, MD, FAAOS, is a board-certified orthopaedic surgeon and fellowship-trained shoulder and elbow specialist providing advanced elbow care in West Palm Beach, Jupiter, and Palm Beach Gardens, FL. He evaluates the underlying tendon condition and develops an individualized treatment plan based on each patient's symptoms and goals.
What is Elbow Anatomy?
The elbow is a joint made up of three bones: the upper arm bone, the humerus, and the two forearm bones, the radius and ulna. The lower end of the humerus has bony bumps called epicondyles that serve as sites of attachment for major tendons and muscles that help in arm movement. The bump on the outside of the elbow is called the lateral epicondyle. It helps in the attachment of the tendons and muscles that help extend your fingers and wrist.
What is Tennis Elbow?
Tennis elbow is a common name for the elbow condition lateral epicondylitis. It is an overuse injury that causes inflammation and microtears of the tendons that attach to the lateral epicondyle.
Tennis elbow is a painful condition occurring from repeated muscle contractions at the forearm. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments.
Tennis elbow and golfer’s elbow are similar, except that golfer’s elbow occurs on the inside of the elbow and tennis elbow occurs on the outside of the elbow. Both conditions are a type of tendonitis - inflammation of the tendons.
What are the Signs and Symptoms of Tennis Elbow?
The signs and symptoms of tennis elbow can include the following:
- Elbow pain that gradually worsens
- Pain to the outside of the elbow that radiates to the forearm and wrist with grasping objects
- Weak grip
- Painful grip
- Pain that is exacerbated in the elbow when the wrist is bent back
What Causes Tennis Elbow?
Tennis elbow is usually caused by overuse of the forearm muscles but may also be caused by direct trauma such as with a fall, car accident or work injury.
Tennis elbow is commonly seen in tennis players, hence the name, especially when poor technique is used while hitting the ball with a backhand stroke. Other common causes include any activity that requires repetitive motion of the forearm such as painting, hammering, typing, raking, weaving, gardening, lifting heavy objects and playing musical instruments.
How is Tennis Elbow Diagnosed?
Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, MRI or electromyogram (EMG) to detect any nerve compression.
What is the Treatment for Tennis Elbow?
Conservative Treatments for Tennis Elbow
Your physician will recommend conservative treatment options to treat the tennis elbow symptoms. These may include:
- Limit use and rest the arm from activities that worsen symptoms.
- Splints or braces may be ordered to decrease stress on the injured tissues.
- Place ice packs on the elbow to reduce swelling.
- Avoid activities that tend to bring on the symptoms and increase stress on the tendons.
- Anti-inflammatory medications and/or steroid injections may be prescribed to treat pain and swelling.
- Occupational therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
- Pulsed ultrasound may be applied to increase blood flow and healing to the injured tendons.
Lateral Epicondyle Release Surgery
If conservative treatment options fail to resolve the condition and symptoms persist for 6 - 12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Surgery is considered a last resort and only 1 in 10 patients requires surgical intervention. The surgical success rate for relieving tennis elbow pain is 85-95%. The goal of tennis elbow surgery is to remove the diseased tissue around the outer elbow, improve blood supply to the area, and alleviate your symptoms. Your surgeon will decide whether to perform your surgery in the traditional manner or endoscopically. Traditional surgery involves up to a 2” incision in the elbow area.
The endoscopic surgery involves one or two ½” incisions to the outer elbow area, the lateral epicondyle and the use of an endoscope with a camera for viewing internal structures. Each incision is called a portal. A blunt tube, called a trocar, is inserted into each portal prior to the insertion of the endoscope and surgical instruments.
The television camera attached to the endoscope displays the image of the joint on a television screen, allowing your surgeon to view the elbow joint. The large image on the television screen allows the surgeon to see the joint directly and to determine the extent of the problem.
The second portal is used for the insertion of surgical instruments. This portal will be used to move aside soft tissue in order to view the extensor tendon and its attachment on the lateral epicondyle. Your surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the portals (incisions) are closed with sutures or tape.
This surgery is usually performed in an operating room under regional or general anesthesia on an outpatient basis as day surgery.
Endoscopic surgery is much less traumatic to the muscles, ligaments, and tissues than the traditional method of surgically opening the elbow area with long incisions. These incisions result in very small scars, which in many cases are unnoticeable.
What are the Risks and Complications of Tennis Elbow Surgery?
As with any major surgery, tennis elbow surgery may involve certain complications such as:
- Allergic reactions to medications
- Blood loss
- Heart attack, stroke, kidney failure, pneumonia or bladder infection
- Infection
- Nerve damage
- Radial nerve damage, causing numbness, tingling, burning or loss of feeling in the back of the hand and forearm
- Wrist weakness with extension
- Recurrence or failure of relief from symptoms
Why Choose Dr. Hill for Tennis Elbow Surgery?
Specialized Shoulder and Elbow Expertise
Dr. Hill focuses his practice on shoulder and elbow conditions, including disorders affecting the tendons around the elbow. His specialized experience allows him to evaluate persistent tennis elbow and determine whether continued nonsurgical treatment or surgery may be appropriate.
Fellowship-Trained Orthopaedic Surgeon
Dr. Hill completed his orthopaedic surgery residency at St. Louis University followed by a shoulder and elbow surgery fellowship at Rothman Orthopaedic Institute and Thomas Jefferson University Hospitals in Philadelphia. His advanced training includes arthroscopic and reconstructive procedures of the shoulder and elbow.
Thorough Evaluation Before Surgery
Tennis elbow can have symptoms similar to other elbow conditions. Dr. Hill considers your medical history, physical examination, activity level, and imaging when necessary to confirm the diagnosis and identify the source of your pain.
Individualized Treatment Planning
Surgery is generally reserved for persistent tennis elbow that has not responded adequately to appropriate nonsurgical care. Dr. Hill considers the severity and duration of symptoms, tendon condition, functional limitations, and previous treatments before recommending surgery.
Arthroscopic and Surgical Treatment Options
When surgery is indicated, the appropriate technique depends on the condition of the affected tendon and surrounding structures. Surgical treatment may involve removing damaged tissue, addressing associated bone spurs, and repairing or reattaching the tendon when necessary.
Focus on Restoring Elbow Function
Following tennis elbow surgery, rehabilitation can help restore motion, strength, and function. Dr. Hill provides postoperative recommendations based on the procedure performed and the patient's individual recovery.
Tennis Elbow Surgery FAQs
When is surgery recommended for tennis elbow? +
Surgery may be considered when symptoms persist despite an appropriate course of nonsurgical treatment and continue to interfere with daily activities, work, or sports. The timing depends on the severity and duration of symptoms and the patient's response to treatment.
Does tennis elbow always require surgery? +
No. Most people with tennis elbow improve with nonsurgical treatment such as activity modification, physical therapy, bracing, and other appropriate measures. Surgery is generally considered only for selected patients with persistent symptoms.
What happens during tennis elbow surgery? +
Depending on the procedure, the surgeon may remove diseased or damaged tendon tissue, address associated scar tissue or bone spurs, and repair or reattach the affected tendon to the lateral epicondyle. The exact technique depends on the individual condition.
Is tennis elbow surgery performed arthroscopically? +
Some tennis elbow procedures can be performed using arthroscopic techniques, while others may use an open approach. The appropriate technique depends on the patient's anatomy, tendon condition, and the surgeon's assessment.
How long does it take to recover from tennis elbow surgery? +
Recovery varies according to the surgical technique and individual healing. Early recovery generally focuses on protecting the treated tissues and restoring appropriate elbow and wrist motion. Strengthening and gradual return to activities are introduced as healing progresses.
Will I need physical therapy after tennis elbow surgery? +
Physical or occupational therapy may be recommended following surgery. Rehabilitation can help restore range of motion, gradually rebuild forearm strength, and support a safe return to work, sports, and other activities.
What are the risks of tennis elbow surgery? +
Potential complications include infection, bleeding, nerve irritation or injury, stiffness, weakness, persistent or recurrent symptoms, and failure to achieve the desired improvement. Your surgeon will discuss the potential risks and benefits before treatment.
Schedule a Tennis Elbow Consultation in West Palm Beach, Jupiter or Palm Beach Gardens, FL
If chronic tennis elbow is limiting your ability to grip, lift, work, exercise, or participate in sports, Dr. Brian W. Hill, MD, can provide a specialized evaluation and discuss your treatment options. When nonsurgical treatment has not provided sufficient relief, surgical treatment may be considered for appropriately selected patients. Dr. Hill provides shoulder and elbow care for patients throughout West Palm Beach, Jupiter, Palm Beach Gardens, Wellington, and surrounding Palm Beach County communities. Contact the office to schedule an evaluation and learn whether tennis elbow surgery or another treatment approach may be right for you.
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