Tennis elbow release at York Hospital

What is tennis elbow release?

Tennis elbow release is an operation to treat tennis elbow, a condition where the tendons on the outside of your elbow become irritated and painful where they attach near the bone. It's rarely caused by playing tennis itself and can affect anyone whose daily activities put repeated strain on these tendons.

What conditions does tennis elbow release treat?

This operation treats tennis elbow itself, and is normally only considered when the pain, weakness and reduced movement it causes haven't improved with several months of non-surgical treatment.

What are the benefits of tennis elbow release?

Surgery aims to take the tension off the affected tendon, easing your pain and improving movement. Studies suggest around 8 in 10 people are better within 6 months of surgery, whichever technique is used.

Are there different types of tennis elbow release?

There are two main techniques: open surgery and keyhole (arthroscopic) surgery. Both release the damaged tendon at its point of attachment and are usually done as a day case.

In open surgery, your surgeon makes a small cut, around 2–3cm long, over the outer part of your elbow, lifts the muscles to reach the damaged tendon, and removes the unhealthy tissue. In keyhole surgery, two small cuts allow a telescope and instruments into your elbow, so your surgeon can inspect the joint and release the tendon from the inside.

Keyhole surgery tends to allow a slightly faster recovery and lets your surgeon check for and treat any other problems inside the elbow at the same time, though your surgeon will advise which approach suits you best.

What happens before tennis elbow release?

Surgery is normally only considered after 6 to 12 months of non-surgical treatment hasn't worked. This might include physiotherapy, a tennis elbow brace, steroid injections or acupuncture.

Before your operation, your surgeon will see you and mark your affected elbow to confirm the correct arm will be operated on.

What happens during tennis elbow release?

Tennis elbow release is usually done as a day case, so you can go home the same day. The exact steps depend on whether you're having open or keyhole surgery, but in general:

1. You're given an anaesthetic; this may be a local or regional anaesthetic to numb your arm, or a general anaesthetic where you're fully asleep, depending on your surgeon's approach
2. A tourniquet may be used on your arm to stop the blood supply temporarily during the operation
3. Your surgeon releases the damaged tendon from its attachment point and removes any unhealthy scar tissue
4. The wound is closed with stitches or surgical tape, a soft bandage or dressing is applied, and your arm is supported in a sling.

What does recovery from tennis elbow release look like?

Your arm will usually be rested in a sling at first, and it's normal to have some pain and swelling; painkillers and an ice pack can help. If you had keyhole surgery, your bulky bandage is usually removed after about 3 days, though sticky dressings should stay dry for around 2 weeks.

Gentle, unresisted exercises for your elbow and wrist usually start within about 2 weeks, guided by a physiotherapist, and any stitches are normally removed around this time. You should avoid heavy use of the arm for about 6 weeks, though you can gradually build up gentle movement before then.

Strengthening exercises usually start from around 4 to 6 weeks. Most people can return to lighter activities from around 3 months, and a fuller return to repetitive activities or sport usually takes 4 to 6 months.

Improvement can continue for up to a year after surgery, and it's normal to notice a temporary return of symptoms with certain activities during this time. Driving is an individual decision, and you shouldn't drive again until you feel confident and are no longer in pain.

What are the risks and complications of tennis elbow release?

Complications after tennis elbow surgery are uncommon, and the overall risk is low. Infection is rare, but if you notice increasing swelling, redness, throbbing pain, pus, or a high temperature, contact your GP or the surgical team.

Some bleeding from the wound is normal for the first 2 to 3 days; gentle pressure on the dressing usually stops this, but contact your GP or surgical team if it doesn't. Nerve injury is possible but uncommon, and slightly more likely with keyhole surgery, though even if this happens it usually recovers on its own over time.

Stiffness can occasionally follow surgery, though it's rarely a significant problem, and a small number of people continue to have some pain afterwards. Recurrence of tennis elbow after surgery is rare.