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Tennis elbow repair (lateral epicondylitis repair)​

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Lateral epicondylitis, or tennis elbow, is a condition affecting the tendon origins at the outside of your elbow. These forearm tendons bend your wrist, fingers and thumb backwards and all attach at a common point at the elbow called the lateral epicondyle. Tennis elbow occurs when the repeated contraction of the forearm muscles develop a series of tiny tears in these tendons.

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Lateral epicondylitis surgery is generally considered when the overstretched/ torn muscles and tendons at the back of the forearm do not respond sufficiently to conservative, non-invasive physiotherapy and management.

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During surgery, the torn muscles fibres are removed while healthy ends of the remaining tissue are stitched together and repaired back to bone. The repair procedure sometimes involves release of the radial nerve which is situated close to the lateral epicondyle. Irritation of the nerve is commonly associated with tennis elbow.

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Patients will have an incision on the outer aspect of their elbow which will be closed with dissolvable sutures and protected by a waterproof dressing. A back-slab plaster is also likely to be applied.

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Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

 

Postoperatively, patients will have their arm in a sling with a back-slab. Patients must keep all dressings/ bandages intact until their post-operative review with Kemble. A plastic bag tied above the elbow can be used to prevent the arm getting wet during showering, or alternatively a one-handed bath is safe. Kemble will review the wound and advise when it is safe to stop be able to shower and get the area wet.

Encourage patients to keep their fingers and shoulders moving to avoid stiffness. However, the elbow and wrist must be immobilised until the repair mends.

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Initial appointment (10-14 days post-operatively)

  • Remove post-operative dressing and primary dressing of wound;

  • Apply tubigrip (or similar) to elbow to reduce post-operative swelling;

  • Commence scar management if appropriate;

  • Commence AROM elbow, forearm and wrist exercises;

  • Protect repair in wrist brace in between exercises;

  • Light pain free function (lighter than a cup of tea) within splint or brace.​

 

Review Appointment (4 -6 weeks post-operatively)

  • Monitor wrist, elbow, forearm AROM;

  • Continue scar management; 

  • Gradually increase function in and out of splint.

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Review Appointment (6-8 weeks post-operatively)

  • Commence splint wean and strengthening as appropriate;

  • Aim to achieve full elbow and wrist ROM at this stage;

  • Continue scar management;

  • Can start increasing weightbearing;

  • Avoid eccentric wrist and finger extensor contraction until 3 months.

 

Return to activity/sports

  • Dependent on the patient’s hobbies or sport and level of participation, they should avoid heavy lifting or gripping for three to six months.

 

General post-operative things to be aware of

  • It is normal to have some tingling, numbness or weakness following the procedure. This is often due to a nerve block performed pre-operatively to help with pain, or with a local anaesthesia that was injected postoperatively. This will wear off a day or two.

 

Possible complications of this procedure

  • Infection;

  • Reduced strength or flexibility;

  • Recurrence of lateral epicondylitis and pain (up to 25%).

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