Tennis Elbow Surgery
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.
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
Causes of 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.
Diagnosis of Tennis Elbow
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.
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.
- 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. Traditional surgery involves up to a 2” incision in the elbow area.
This surgery is usually performed in an operating room under general anesthesia on an outpatient basis as day surgery.
Risks and Complications of Tennis Elbow
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
Cirugía de Codo de Tenista
El codo es una articulación formada por tres huesos: húmero, radio y cúbito. El extremo inferior del húmero tiene prominencias óseas llamadas epicóndilos, donde se insertan tendones y músculos que ayudan en el movimiento del brazo. La prominencia externa es el epicóndilo lateral, donde se insertan tendones y músculos que extienden los dedos y la muñeca.
¿Qué es el Codo de Tenista?
El codo de tenista es epicondilitis lateral, una lesión por sobreuso que causa inflamación y microdesgarros en los tendones del epicóndilo lateral. Es dolorosa y ocurre por contracciones repetidas del antebrazo. Se observa en deportes como tenis y actividades repetitivas del antebrazo como pintura, martillado, mecanografía, jardinería o tocar instrumentos musicales.
El codo de golfista ocurre en la parte interna del codo, mientras que el de tenista ocurre en la externa. Ambos son tipos de tendinitis.
Síntomas
- Dolor en el codo que empeora gradualmente
- Dolor en la parte externa del codo que se irradia al antebrazo y muñeca al sujetar objetos
- Debilidad de agarre
- Dolor al agarrar objetos
- Dolor cuando la muñeca se dobla hacia atrás
Causas
- Sobreuso de los músculos del antebrazo
- Trauma directo, caída, accidente de auto o lesión laboral
Diagnóstico
Se realiza revisión de historial, examen físico y estudios como radiografía, MRI o electromiograma (EMG).
Tratamiento
Conservador
- Descansar el brazo y limitar actividades que empeoren los síntomas
- Férulas o soportes
- Aplicación de hielo
- Evitar actividades que aumenten estrés en los tendones
- Medicamentos antiinflamatorios y/o inyecciones de esteroides
- Terapia ocupacional para fortalecimiento y estiramiento
- Ultrasound pulsado para aumentar flujo sanguíneo y cicatrización
Cirugía (Liberación del Epicóndilo Lateral)
Si el tratamiento conservador falla tras 6-12 meses, se puede realizar cirugía llamada liberación del epicóndilo lateral. Solo 1 de cada 10 pacientes requiere cirugía. Éxito del 85-95%.
Objetivo: eliminar tejido enfermo, mejorar irrigación y aliviar síntomas. Incisión hasta 2”.
Se realiza en quirófano bajo anestesia general como cirugía ambulatoria.
Riesgos y complicaciones
- Reacciones alérgicas a medicamentos
- Pérdida de sangre
- Infarto, accidente cerebrovascular, fallo renal, neumonía o infección urinaria
- Infección
- Daño nervioso, especialmente al nervio radial
- Debilidad de la muñeca al extender
- Reaparición de síntomas