Surgery treatment of tennis elbow
Healing occurs on its own in 90% of patients. There are a number of conservative treatments: rest, orthotic devices, oral anti-inflammatories, cryotherapy, physiotherapy, occupational therapy, acupuncture, shock wave therapy, etc. While cortisone injections are very effective, they must be used sparingly, for injections could damage the tendon.
If the pain is not resolved after six months of treatment (some people prefer to wait 12 months), further investigation is warranted. A MRI scan or ultrasound will be able to show a tear or the severity of the tendinopathy.
A new treatment involving injection of platelet-rich plasma (PRP) is enjoying more widespread use. Blood is drawn from the patient; the platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. The increased concentration of platelets is then combined with the remaining blood and injected into the elbow. There is also a commercial equivalent which uses the patient’s stem cells. Both are promising alternatives to surgery, but their success rate currently stands at only about 75% and healing time is several months. Such a procedure will be less effective if there are tendon tears.
When conservative treatment fails, surgery is the solution. The procedure has an undeserved bad reputation that is totally unfounded: serious studies have in fact shown that the success rate approaches 85% or 90% if the correct diagnosis is made in the first place. My own success rate is above 95% since starting my practice; healing, which varies from person to person, takes three to four months.
Several surgical techniques are possible. The one I have used for several years is performed under local anesthesia (as used by dentists) and involves the release of the epicondyle tendon which then forms scar tissue and attaches to its intact neighbour: the long wrist extensor. Elbow mobilization is encouraged as of the following day so that healing occurs without excessive tension in the arc of movement. Physiotherapy is rarely necessary and complications (infections, stiffness, neurological or vascular lesions) are infrequent.