Lateral Epicondyle Surgery (Tennis Elbow Release)

Overview

Surgery for lateral epicondylitis (tennis elbow) is considered when conservative treatment fails to relieve symptoms after 6 to 12 months. The procedure involves removing the damaged portion of the extensor tendon and, in some cases, releasing the tendon origin from the lateral epicondyle. Surgery can be performed using open, arthroscopic, or percutaneous techniques.

Indications

This procedure may be considered when:

• •Lateral epicondylitis not improved after 6 to 12 months of conservative treatment
• •Persistent pain significantly affecting daily activities or work
• •Failure of physical therapy, bracing, and activity modification
• •Inadequate or temporary relief from corticosteroid injections
• •Imaging confirming tendon pathology without other explanations for pain
• •Patient preference after understanding risks and alternatives

How It Works

The procedure typically involves several coordinated steps:

• •The procedure is typically performed under regional or general anesthesia
• •Open technique: An incision is made over the lateral epicondyle
• •The common extensor tendon origin is exposed
• •Degenerative or damaged tendon tissue is identified and excised
• •The remaining tendon may be repaired or reattached to bone
• •Some techniques involve releasing the extensor carpi radialis brevis origin
• •Arthroscopic technique: Small portals allow camera-guided debridement
• •Percutaneous techniques use needle or small incisions for tendon release
• •The wound is closed and a dressing or splint is applied

Risks

As with any surgical procedure, potential risks include:

• •Persistent or recurrent pain
• •Infection
• •Nerve injury (posterior interosseous nerve or lateral antebrachial cutaneous nerve)
• •Weakness of wrist or finger extension
• •Elbow stiffness
• •Scar tenderness
• •Need for additional surgery
• •Failure to return to previous activity level

Recovery Expectations

Recovery follows a gradual progression:

• •The procedure is typically performed as outpatient surgery
• •A splint or brace may be worn for 1 to 2 weeks
• •Early gentle range of motion exercises are often encouraged
• •Physical therapy begins within a few weeks focusing on stretching and strengthening
• •Progressive loading of the forearm muscles occurs over 6 to 12 weeks
• •Return to light activities may occur within 4 to 6 weeks
• •Return to full activities and sports may require 3 to 6 months
• •Grip strength may continue to improve for several months

Alternatives

Depending on individual circumstances, alternatives may include:

• •Continued conservative treatment with physical therapy
• •Activity and ergonomic modification
• •Counterforce bracing
• •Corticosteroid injections
• •Platelet-rich plasma (PRP) or other regenerative injections
• •NSAIDs and other pain management strategies
• •Shockwave therapy

Sources

• AAOS OrthoInfo – Tennis Elbow
• Mayo Clinic – Tennis Elbow Treatment
• Cleveland Clinic – Tennis Elbow Treatment
• American Academy of Orthopaedic Surgeons