Should I have surgery to treat tennis elbow?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Surgery is considered a last resort for treating tennis elbow. However, if you still have elbow and forearm pain and stiffness after 6 to 12 months of non-surgical treatment (rest, ice, rehabilitation), you may consider surgical treatment. When making your decision, keep in mind:

• Resting the tendon is important. A typical case of tennis elbow takes 6 to 12 months to heal. In some cases, the pain lasts for 2 years or longer.¹ With tendon rest and rehabilitation and (possibly) 1 to 3 corticosteroid shots, most people with tennis elbow heal within a year.
• Tennis elbow tendon damage worsens when you continue painful, aggravating activity.
• There are various surgical procedures for treating tennis elbow. However, there is no evidence to support any one technique as being most effective.²
• Tennis elbow surgery does not guarantee a cure. According to a few studies of people who have had tennis elbow surgery, 85% to 90% gain full relief.³

See an illustration of tennis elbow .

Medical Information

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What is tennis elbow?

“Tennis elbow,” also called lateral epicondylitis, is a term that describes soreness or pain on the outside (lateral) part of the elbow. Tennis elbow symptoms occur when there is damage to the end of the tendon that connects lower-arm and hand muscles to the upper arm bone at the elbow.

See an illustration of tennis elbow .

Tennis elbow is usually caused by repeated twisting movements of the hand, wrist, or forearm done during everyday activities, such as using a screwdriver or scissors, gardening, and various sports.

What kind of surgery is done for tennis elbow?

Your doctor may recommend an arthroscopic examination of your outer elbow area, with a plan to do surgery if necessary. The most common types of tennis elbow surgery are:

• Removal of scar tissue from the damaged tendon area.
• Release (cutting) of the tendon that attaches the extensor carpi radialis brevis (ECRB) muscle to the bone. The ECRB attachment is thought to be the most common site of tennis elbow damage.⁴

Other types of procedures include:

• Drilling small, shallow holes in the bone to encourage growth of new blood vessels. This helps bring blood to the area and stimulates tendon healing.
• Repairing (reattaching) tendon tears if it's possible to do it without overtightening the tendon.

See an illustration of tennis elbow .

What are the risks of tennis elbow surgery?

Risks of tennis elbow surgery include:

• Slight loss of ability to straighten the arm.
• Elbow pain that persists or recurs.
• Infection, blood loss, and nerve damage (which are risks in all surgeries).
• General or regional anesthesia risks, such as breathing problems.

When is tennis elbow surgery appropriate?

Surgical tendon repair is a reasonable treatment when there are large tears in the tendon from a sudden (acute) injury or if there is other severe damage to the elbow.

Surgery may be a reasonable treatment for tennis elbow if you:

• Have elbow pain after 6 to 12 months of tendon rest and rehabilitation.
• Cannot do normal daily-living and job-related activities because of elbow pain.
• Have had corticosteroid shots and still have elbow pain.

If you need more information, see the topic Tennis Elbow.

Your Information

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Your choices are:

• Continue with tendon rest and rehabilitation and possibly other non-surgical treatment measures.
• Have surgery to treat tennis elbow.

The decision about whether to have surgery for tennis elbow takes into account your personal feelings and the medical facts.

Deciding about surgery for tennis elbow

Reasons to have surgery for tennis elbow

Reasons not to have surgery for tennis elbow

You have elbow and forearm pain despite 6 to 12 months of tendon rest and rehabilitation, and: Your condition is definitively diagnosed as tennis elbow. Your livelihood depends on eliminating tennis elbow pain. Your daily living or sport activities are severely limited by tennis elbow pain. You have had corticosteroid shots that did not help. Are there other reasons you might want to have surgery?

Your injured tendon hasn't had enough time to heal (6 to 12 months). You haven't faithfully followed a rehabilitation program for stretching and strengthening your arm. Surgery doesn't offer you a guaranteed cure. In small studies, about 10% of people still have pain with aggressive activity after surgery. (On the other hand, 85% to 90% report full pain relief.)3 Tennis elbow surgery research isn't complete enough to recommend or discourage particular surgical procedures.2 Your doctor is not certain of the cause of your symptoms. Your opposite elbow did not respond well to surgery. You have another medical condition, such as heart, lung, or kidney disease, that may increase the risks of surgery or general or regional anesthesia. Are there other reasons you might not want to have surgery?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery for tennis elbow. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have used tendon rest and rehabilitation measures for 6 to 12 months.	Yes	No	Unsure
My doctor is absolutely sure that I have tennis elbow.	Yes	No	Unsure
My daily-living activities are painful.	Yes	No	NA*
My work activities are painful.	Yes	No	NA
My sports activities are painful.	Yes	No	NA
I am concerned that the tendon is becoming more damaged over time.	Yes	No	Unsure
I am willing to stick to a rehabilitation program after surgery.	Yes	No	Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery for tennis elbow

Leaning toward NOT having surgery for tennis elbow

Return to the topic Tennis Elbow.

References

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Citations

1. Smidt N, et al. (2002). Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: A randomised controlled trial. Lancet, 359(9307): 657–662.

2. Buchbinder R, et al. (2006). Surgery for lateral elbow pain. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

3. Gabel GT, Morrey BF (1998). Tennis elbow. AAOS Instructional Course Lectures, 47: 165–172.

4. Putnam MD, Cohen M (1999). Painful conditions around the elbow. Orthopedic Clinics of North America, 30(4): 109–118.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	David Pichora, MD, FRCSC - Orthopedic Surgery
Last Updated	February 14, 2007