Lateral epicondylitis, commonly known as Tennis Elbow, is a frequent overuse injury causing persistent pain on the outside of the elbow. This condition results from repetitive strain on the tendons that connect the forearm muscles to the bony prominence of the elbow joint. Surgery is an uncommon intervention, typically reserved for less than 10% of cases when symptoms are chronic and severe.
What is Tennis Elbow?
Tennis Elbow is a degenerative condition affecting the common extensor tendon, most frequently involving the extensor carpi radialis brevis (ECRB). This tendon attaches to the lateral epicondyle, the small bony bump on the outer side of the elbow. The condition develops from repetitive micro-trauma or eccentric overload, causing tiny tears and structural changes within the tendon tissue.
The resulting pain is centered directly over the lateral epicondyle, often worsening when performing activities that require gripping or lifting. Many people experience tenderness when the area is pressed, along with pain that may radiate down the forearm and sometimes into the wrist. This weakening of the tendon attachment can cause a noticeable decrease in grip strength, making simple tasks difficult.
The Non-Surgical Treatment Approach
The treatment plan for Tennis Elbow begins with a conservative, non-surgical approach, which successfully resolves symptoms for the vast majority of people. The initial step involves activity modification, which means avoiding or changing the movements that aggravate the tendon. This allows the damaged tendon tissue to rest and begin the natural healing process.
Physical therapy is a cornerstone of recovery, focusing on specific exercises designed to promote tendon strength and healing. This often includes eccentric exercises, where the muscle lengthens while contracting, which helps to strengthen the tendon structure. Therapists may also incorporate stretching and general strengthening of the forearm muscles to improve overall resilience and load tolerance.
Supportive devices, such as counterforce braces or wrist splints, can be worn to help relieve tension on the ECRB tendon at its attachment point. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are often used for short periods to manage pain. For cases that require more targeted relief, injection therapies are sometimes considered.
Corticosteroid injections can provide short-term pain relief by reducing local inflammation, though they are sometimes linked to delayed long-term recovery. Conversely, Platelet-Rich Plasma (PRP) injections utilize a concentration of the patient’s own platelets, which contain growth factors aimed at stimulating the tendon’s repair process. This comprehensive non-operative protocol is typically followed consistently for at least 6 to 12 months before any surgical discussion takes place.
Criteria for Surgical Consideration
Surgical intervention for Tennis Elbow is reserved for chronic cases that have failed to improve after a prolonged period of conservative management. A patient must typically endure persistent, debilitating pain for 6 to 12 months, despite consistently adhering to the non-surgical protocol. The pain must be severe enough to significantly impair daily function, affecting work, sleep, and simple activities of living.
Imaging studies, such as MRI or ultrasound, confirm severe tendon degeneration or a significant tear that is unlikely to heal spontaneously. The goal of surgery is to remove the diseased or damaged tissue from the tendon’s origin. This process, known as debridement, stimulates a fresh healing response in the area.
The procedure is commonly performed using one of two methods: open surgery or arthroscopic surgery. Open surgery involves making a small incision over the elbow to directly visualize and excise the damaged part of the tendon. Arthroscopic surgery is a minimally invasive alternative, utilizing small instruments and a camera inserted through tiny incisions to achieve the same result.
Recovery Timelines and Prognosis
The recovery timeline for Tennis Elbow varies depending on the treatment path taken. For those who respond to conservative treatment, noticeable improvement usually begins within 6 to 12 weeks of starting therapy. A full resolution of symptoms can take anywhere from six months to over a year.
Recovery following surgery is a structured and prolonged process due to the need for tissue healing. Post-operative rehabilitation focuses on regaining strength and mobility, typically lasting several months. Most people can expect a gradual return to full activity, including sports or heavy manual work, within four to six months after the procedure.
The overall prognosis is excellent, regardless of whether the condition is treated conservatively or surgically. Surgical success rates are high, often exceeding 90% in terms of pain relief and improved function. A return to normal function is highly probable, provided the individual commits fully to the prescribed rehabilitation plan.