Elbow Epicondylitis Repair

What is Elbow Epicondylitis?

Lateral epicondylitis of the elbow, also called tennis elbow, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and micro-tears in the tendons that attach to the lateral epicondyle of the humerus (upper arm bone). The lateral epicondyle is the bony prominence that is felt on the outside of the elbow.

Medial epicondylitis also called golfer’s elbow is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on the inside of the elbow.

Signs and Symptoms of Elbow Epicondylitis

Signs and symptoms of elbow epicondylitis (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 is exacerbated in the elbow when the wrist is bent back

Signs and symptoms of golfer’s elbow can include the following:

• Elbow pain that appears suddenly or gradually
• Achy pain to the inner side of the elbow during activity
• Elbow stiffness with decreased range of motion
• Pain that radiates to the inner forearm, hand or wrist
• Weakened grip
• Pain worsens with gripping objects
• Pain is exacerbated in the elbow when the wrist is flexed or bent forward toward the forearm

Causes of Elbow Epicondylitis

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. It is commonly seen in tennis players, hence the name, especially when poor technique is used when 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.

Golfer’s elbow is usually caused by overuse of the forearm muscles and tendons that control wrist and finger movement but may also be caused by direct trauma such as with a fall, car accident or work injury. It is commonly seen in golfers; hence the name, especially when poor technique or unsuitable equipment is used when hitting the ball. Other common causes include any activity that requires repetitive motion of the forearm such as: painting, hammering, typing, raking, pitching sports, gardening, shoveling, fencing and playing golf.

Diagnosis of Elbow Epicondylitis

Tennis elbow or golfer’s elbow should be evaluated by an orthopedic specialist for proper diagnosis and treatment. Your physician will review your medical history, perform a physical examination and order diagnostic studies such as X-rays.

Treatment of 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.
• Ice packs to the elbow for swelling
• Avoid activities that tend to bring on the symptoms and increase stress on the tendons.
• Anti-inflammatory medications and/or steroid injections to treat pain and swelling may be ordered.
• Occupational therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
• Pulsed ultrasound may be utilized to increase blood flow and healing to the injured tendons.

Elbow Epicondyle Release Surgery

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend you undergo epicondyle release surgery.  

Your surgeon will decide whether to perform your surgery in the traditional manner or endoscopically.  Traditional surgery involves up to a 2-inch incision in the elbow area, whereas endoscopic surgery involves one or two ½-inch incisions and the use of an endoscope with a camera for viewing internal structures. The television camera attached to the endoscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the elbow joint at cartilage, ligaments, nerves and bone. The goal of elbow epicondylitis surgery is to remove the diseased tissue around the outer or inner elbow improving blood supply to the area and alleviating your symptoms. Surgery is usually performed in an operating room under regional or general anesthesia on an outpatient basis as day surgery.

Your surgeon makes one or two small incisions, about ½ inch each, over the affected epicondyle. Each incision is called a portal. These incisions result in very small scars, which in many cases are unnoticeable. A blunt tube, called a trocar, is inserted into each portal prior to the insertion of the endoscope and surgical instruments. With the images from the endoscope as a guide, the surgeon can look for any pathology or anomaly. 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. The 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.

Postoperative Care Following Elbow Epicondylitis Surgery

After the surgery is completed, the portals (incisions) are closed by suturing or by tape. 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. After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon’s preference.

Risks and Complications of Elbow Epicondylitis Surgery

As with any major surgery, elbow epicondylitis surgery may involve certain complications such as:

• Allergic reactions to medications
• Blood loss
• Heart attacks, strokes, kidney failure, pneumonia, bladder infections
• Infection
• Nerve damage
• Radial nerve damage causing numbness, tingling, burning or loss of feeling in the back of the hand and forearm area
• Wrist weakness with extension
• Recurrence or no improvement with surgery