Tennis Elbow Release Surgery, Recovery and Risks

Tennis elbow release, also known as lateral epicondylitis release, is a surgery used to treat tennis elbow. Tennis elbow is a painful condition in which the tendons in the elbow get damaged due to strain or overuse. The surgery is executed when physiotherapy, medications, and other conservative treatments fail to cure the pain. It is found to be effective in around 85%-90% of cases. 

Tennis elbow generally weakens the grip strength, affecting individuals to do simple things such as lifting a cup. In the surgery, the damaged piece of the tendon is cut and removed to reattach the healthy part to the bone, relieving the tension in the elbow. 

The various benefits of tennis elbow release are as follows:

1. Relief from uncontrollable pain and swelling
2. Regaining the strength to hold objects
3. Regaining the motion in the arms

Tennis elbow is very common among athletes. But it is not limited to just that segment. People whose jobs require doing the same elbow movement over and over again can experience repetitive-stress injuries in the extensor tendon. For example, professionals like:-

1. Plumbers
2. Painters
3. Carpenters
4. Butchers
5. Musicians

Anyone who is suffering pain or restriction in elbow movement due to a tennis elbow needs to consult a doctor for surgery. 

The surgery for tennis elbow can be performed in two ways:

1. Open surgery: The surgeon makes an incision over the injured tendon to remove the damaged part and reattach the healthy part of the tendon to the bone. He/she might need to remove a tiny piece of bone in the elbow to improve the blood flow and quicker recovery. 
2. Arthroscopic surgery: In this procedure, the surgeon makes small incisions to insert a thin tube-like instrument known as an arthroscope. The instrument has an attached camera that helps the surgeon clearly view and remove the damaged part. 

In both surgeries, the patient is allowed to leave the hospital on the same day after the surgery is performed.

1. The patient needs to mention to the doctor all the medicines, vitamins, herbs and other supplements that he/she is taking. 
2. Blood-thinning medicines such as aspirin, ibuprofen (Advil), and naproxen (Aleve, Naprosyn) should be avoided as per the doctor's instructions. 
3. The patient is advised to undergo a pre-anaesthetic checkup. 
4. Open and arthroscopic surgery is usually performed under general or regional anaesthesia. 
5. The doctor briefs the patient about the surgery procedure and the date/time of the appointment.  
6. The patient can ask about all the benefits and risks involved in open and arthroscopic surgery. 
7. Smoking can affect healing post-surgery, so the patient needs to quit smoking at the earliest. 
8. The doctor might advise fasting before the surgery.

1. After checking in at the hospital, the patient first signs the consent form.
2. The patient is then made to change into the hospital gown. 
3. The healthcare team records the weight and height and monitors the vitals to check the temperature, blood pressure, and heart rate. 
4. If required, the surgical site may be shaved.

1. The anesthesiologist induces the anaesthesia to numb the pain during the surgery. 
2. The patient is laid on the back facing upwards by the healthcare team. 

In case of open surgery:-

1. The surgeon makes a 3-7 cm long incision over the lateral epicondyle (along the elbow). 
2. Once the incision is made, soft tissue is gently moved aside to expose the extensor tendon underneath. 
3. The tendon is then moved apart to reveal the underlying tissues and bone. 
4. The damaged part of the tendon or osteophytes is removed and cleaned through cutting and scraping tools. 

In case of arthroscopic surgery:-

1. Two or three incisions, smaller than 3 cm are made.
2. A  thin tube (called scope) with a tiny camera and light is inserted through the incisions. 
3. The camera in the scope helps the surgeon view inside the elbow area on the video monitor to remove the unhealthy part of the tendon. 
4. After the surgery, the surgeon closes the incision(s) with sutures or stitches.

1. Even after coming home, the patient needs to keep the arm in a sling for a week or two so that it remains in a still position. 
2. The patient needs to follow the doctor's instructions for bathing to avoid the stitches getting wet. 
3. The bandages will also need changing as instructed by the health care providers. 
4. While sitting or resting, keeping the arm elevated and supported with pillows will ease the pain. 
5. Putting ice on the wound can also help in reducing swelling and relieving pain. 
6. Normally it takes two to six weeks to return to normal activities, three to twelve weeks to restart work, and four to six months to resume sports.

First follow-up appointment

1. After seven to ten days of the surgery, the patient needs to visit the doctor to get the stitches removed. 
2. Depending on the recovery, the doctor might give a smaller splint or sling that the patient needs to wear for two or more weeks. 
3. The patient needs to undergo rehabilitation exercises to increase flexibility and improve the movement of the elbow.
4. The doctor or a physiotherapist will help with the right exercises to regain elbow strength. Some of the exercises may include: 
   1. Wrist movements like extension and flexion
   2. Shoulder rotations
   3. Hand squeezing exercises
   4. Arm pedalling using an arm bike
   5. Eccentric and concentric weight training using light dumbbells. 

Post recovery

1. Generally, the patients can resume their work after 6-12 weeks of the surgery. 
2. If the work requires repetitive elbow movements, care needs to be taken accordingly to avoid excess stress.
3. Lifting heavy weights should also be avoided. 
4. If the pain continues, the patient should visit the doctor again to investigate the causes. 

The tennis elbow surgery can have some risks involved, which include: 

1. Infection in the wound. 
2. Nerve damage resulting in tingling, numbness, and muscle weakness in the hands and forearm. 
3. Damage to the elbow's blood vessels.
4. Reduced flexibility

If the patient notices any of the following signs after the surgery, it is important to consult the doctor right away: 

1. Persistent pain
2. Inflammation that is not going away
3. Redness around the wound
4. Bleeding or any other leakage from the wound
5. Fever