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Lateral Epicondylitis, Tennis Elbow, and Tennis Elbow Release
Lateral epicondylitis, or tennis elbow, is the most common cause of pain on the lateral, outside part of your elbow. The most common symptom is pain on the side of your elbow and back of your forearm any time you lift something with your palm facing downward. As time goes on, that pain can happen all the time, even when you are resting. Tennis elbow is very similar to tendonitis, which is an inflammation of the attachments of muscles to bone.
Tennis elbow involvesthe Extensor Carpi Radialis Brevis, or ECRB. In addition to inflammation, there is usually degeneration of the tendon. The breakdown of the tendon looks like a hole or a tear within the tendon that can be seen with a MRI or during surgery. Alternative causes of pain include a posterolateral plica which causes painful clicking on the back-outside portion of your elbow. This instability is usually the result of a fall or trauma to your elbow. Additionally, radiocarpal arthritis, which is a wearing away of the smooth covering of the elbow joint may cause stiffness along with pain.
Your history, examination, and radiographs will help you and your doctor determine what the exact cause of your pain. Tennis elbow pain will usually go away on its own, but that may take up to two years. Your doctor will discuss a range of treatments to alleviate the pain. Initial treatment of lateral epicondylitis and tennis elbow is usually nonoperative. This treatment may include wrist or elbow braces, physical therapy, anti-inflammatory medication, or a cortisone injection into your elbow.
Arthroscopic and Open Tennis Elbow Release
If you continue to have pain or if you cannot get back to your normal activities after nonoperative treatments, your doctor may offer you a surgery known as “arthroscopic tennis elbow release” or “open tennis elbow release.” During both of these procedures, the surgeon uses specially designed instruments to remove the degenerated portion of the ECRB tendon and sew the torn tendon and muscle back to the bone. During both the arthroscopic and open operations, your surgeon will remove the degenerative, pain causing portion of the stitches that hold the ECRB muscle down to the bone. This will allow the two to grow and heal back together.
The arthroscopic surgery is completed using three or four ¼ inch incisions around the elbow, while the open procedure is carried out through a single ¾ inch incision directly over the injured tendon. There are benefits to both procedures, and your surgeon will discuss which option is best for you.
This is a day surgery procedure that typically takes less than one hour. You will be seen by an anesthesiologist prior to surgery, who will discuss the option of putting another kind of injection in your arm so that your whole arm goes to sleep prior to the surgery and stays asleep for 12 to 24 hours afterwards. Additionally, you will go to sleep with general anesthesia for the entirety of the surgery.
The surgery takes less than one hour. When you wake up, you will have a sling and possibly a splint stabilizing your elbow. You will stay in the recovery room until your pain is controlled and you are ready to leave for home.
The healing process takes approximately three months. Your activities will be limited during this recovery period.