My orthopedic surgeon wants to do an arthroscopic, percutaneous release of the tendon that's causing my tennis elbow. The whole thing (as it was described to me) sounds too easy. What am I missing here? Is it really possible that this pain I've suffered will be gone after a quick snip, snip?
Lateral epicondylitis, otherwise known as "tennis elbow" can be a difficult problem to treat. Recent research has shown us that partial tears of the extensor carpi radialis brevis (ECRB) tendon just don't heal right. After the acute injury, repetitive microtrauma results in an area of fibrosis (scarring) rather than inflammation. Understanding the underlying pathology may help you make decisions about treatment that are right for you with your surgeon's advice, counsel, and guidance.
The idea that lateral epicondylitis isn't really an "-itis" (inflammatory) condition at all has been made clear by microscopic studies of the affected tissue. The lack of blood supply to the area (called hypovascular zones) is a key feature of this problem.
What do the experts have to say about treatment? Well, everyone agrees that conservative care should be first and foremost. But what that should be remains a point of debate and controversy. There are many choices available from the wait-and-see approach, to the use of antiinflammatory medications, steroid or platelet-rich plasma injections, shock-wave therapy, physical therapy, and splinting.
And even within each of those treatment choices, there remains considerable uncertainty about what works best. Stretching, strengthening, soft tissue mobilization, deep friction massage, and electrical stimulation all seem to have some benefit. But is there some way to combine two or more of these approaches for the best results? And if so, which two (or three -- or more) work together to produce optimal outcomes? These are questions current research has not been able to answer just yet.
We do know that in up to 90 per cent of all cases, conservative care has the intended effect. Patients report decreased pain, improved strength, and pain free return of full function of hand, wrist, and forearm. It may take up to a full year to get those kinds of results but most patients agree it is worth the time and effort.
For those few people who do not get the hoped for improvements, surgery is a final option. Here again, there are several choices and no real evidence that one approach works better than another. The surgeon may remove the diseased portion of the extensor carpi radialis brevis (ECRB) tendon, perform a tendon repair, or surgically release the tendon.
Percutaneous (through the skin) release has a good track record with decreased pain, improved strength, and return-to-work for many patients. The downside of this surgical approach is that the surgeon is unable to look inside the joint for any other damage or injury that might be part of the problem. There is also the potential risk for nerve damage and an incomplete release of the tendon.
If you started with conservative care, and gave it a full year, but didn't make enough progress, then surgery may be the next option recommended. If you are feeling uncertain about the percutaneous approach, ask your surgeon to describe other possible surgical options and explain why the percutaneous release is advised for you. The information provided here may help you better understand the explanation.
Namory D. Bagayoko, MD, and Stephen F. Brockmeier, MD. Current Controversies in the Management of Lateral Epicondylitis. In Current Orthopaedic Practice. September/October 2012. Vol. 23. No. 5. Pp. 480-485.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.