Tennis Elbow Release Info Evidence Consent

Tennis elbow release surgery — for persistent pain despite physiotherapy and other conservative treatments.

Why this operation has been suggested

Tennis elbow is a common condition where the tendons on the outside of your elbow become painful and inflamed. Most people recover within six months to one year without surgery, and about 90% of patients find their symptoms resolve on their own within a year. Because your surgeon cannot predict who will heal without help, they usually recommend trying non-surgical treatments first.

Your surgeon has suggested this operation because you have persistent symptoms that have not improved with standard care. This procedure involves making a single small cut to release the tight tendon causing your pain. It is designed for the small group of patients who do not respond to other methods. The main goal is to provide lasting pain relief and help you return to your normal activities.

Before the operation

Most people with tennis elbow get better without surgery, so your surgeon may suggest trying non-surgical treatments first. You might need an X-ray or MRI to check your elbow, or blood tests to ensure you are fit for the procedure. Please fast before your surgery and stop taking certain medicines as your surgeon instructs. Arrange for someone to drive you home and bring a list of all your current medications. Wear comfortable clothing to your appointment. Your surgeon will perform an open operation using a single incision over the painful area.

On the day

You will arrive at the hospital and meet your surgeon and the anaesthetist. They will review your health and answer any questions you have before you go to the operating theatre. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.

Your surgeon will make a single conventional incision over the operative site to perform the release. The procedure itself is brief, and you will wake up in the recovery area as the anaesthetic wears off. You will rest there for a short time while the nursing team checks that you are comfortable and stable before you go home.

What the operation involves

Your surgeon will make a single cut over the outer part of your elbow. This is an open approach, meaning they work directly through this one incision rather than using small keyhole cameras. They will carefully separate the tissues to reach the tendon that is causing your pain.

Inside, your surgeon will remove the damaged part of the tendon where it attaches to the bone. They may also gently scrape the bone surface to encourage healing. This process is called a release. It removes the worn-out tissue that is no longer working properly. Once the damaged area is cleared, your surgeon will close the cut with stitches or glue.

The procedure focuses only on the specific spot where the tendon is frayed. Your surgeon will not need to use special anchors or screws for this release. They will simply remove the bad tissue and let your body heal the rest. This direct approach allows them to see exactly what needs to be fixed.

After the operation

You will wake up in the recovery ward. Your surgeon uses a single conventional incision over your elbow. You will have a dressing and a sling or brace on your arm. Pain is managed with standard medication. You can usually go home the same day. You must have someone stay with you for the first 24 hours to help you. Most patients feel better quickly, though full recovery can take up to 12 to 18 months.

Recovery

Most people with tennis elbow find their symptoms fade on their own within one year. Your body has a steady healing rhythm, often resolving pain within three to four months. Because recovery happens naturally for most, surgery is usually reserved for those who do not improve with rest and therapy. If you do proceed, you can expect near 90% satisfaction with the results.

After your open surgery, you will have a single small incision over the sore spot on your elbow. In the first few days, you may feel some swelling and discomfort around this area. Your surgeon will guide you on using a sling or brace to protect the arm while you rest. You will likely need to sleep with your arm slightly elevated to help reduce swelling.

As the swelling settles, you will begin gentle movement exercises with your physiotherapist. You will focus on regaining strength and range of motion without straining the healing tendon. Your surgeon will tell you when it is safe to resume daily tasks like driving or lifting. Your specific timeline may differ from others, so follow the advice of your surgeon and physio team closely.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Sometimes the pain in your outer elbow does not go away after surgery. This is more likely if you had many injections before the operation. If your symptoms do not improve, tell your surgeon at your next check-up.

Infection is a possible risk with open surgery. You might notice redness spreading from the cut, warmth, or swelling that gets worse. If you see these signs, call the clinic right away so they can treat it.

Rarely, the surgery might not work well enough, and you could need another operation later. This is uncommon, but if your pain returns or gets worse over time, let your surgeon know.

Your surgeon uses an open approach with a single cut over the elbow. While other methods exist, this specific technique carries a similar risk of complications to other ways of doing the surgery.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if you have a fever, increasing redness, or discharge from your wound. Go to emergency if you feel sudden severe pain, swelling in your calf, or shortness of breath. Contact us immediately if you lose sensation or cannot move your arm. Most cases of tennis elbow resolve within 6 months without surgery. However, we need to see you if symptoms do not improve or get worse.

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Evidence & references

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Anatomy & Pathophysiology

• The pathologic tissue in tennis elbow involves the undersurface of the extensor carpi radialis brevis tendon [1].
• The origin of the extensor carpi radialis brevis is visualized during arthroscopic tennis elbow release [1].
• Decortication of the lateral epicondyle and lateral epicondylar ridge is performed to address pathologic tendinous attachment [1].
• Undersurface tears of the extensor carpi radialis brevis are a finding in tennis elbow release procedures [1].
• Medial capsular injury may occur and allow excessive fluid extravasation during arthroscopic elbow procedures [1].
• A 30-degree arthroscope is adequate to view around the corner for most of the arthroscopic tennis elbow release procedure [1].
• A 70-degree arthroscope may be required in rare instances during arthroscopic tennis elbow release [1].
• The proximal medial or superomedial portal is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [1].
• The trocar and sheath for the proximal medial or superomedial portal are introduced anterior to the intermuscular septum [1].
• The trocar is directed toward the radial head while maintaining contact with the anterior aspect of the humerus [1].
• The superolateral portal is established with an 18-gauge needle through the lesion [1].
• Debridement of the capsule and pathologic tendinous attachment of the extensor carpi radialis brevis is performed using a curet and motorized shaver [1].
• Decortication of the lateral epicondyle can be done with an arthroscopic burr, handheld instruments, or electrocautery [1].

Treatment

• Arthroscopic tennis elbow release is described as technique 52.39 [1].
• The patient is placed prone on the operating table after intubation [1].
• Two rolled towels are placed longitudinally under the patient's thorax [1].
• All bony prominences are padded well [1].
• The affected extremity is positioned with the ipsilateral shoulder abducted to 90 degrees [1].
• The arm is supported with a precut foam holder [1].
• Anatomic landmarks and portal sites are marked prior to the procedure [1].
• The joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [1].
• The proximal medial or superomedial portal is established approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [1].
• The trocar and sheath are introduced anterior to the intermuscular septum [1].
• Contact with the anterior aspect of the humerus is maintained at all times as the trocar is directed toward the radial head [1].
• A 2.7-mm, 30-degree arthroscope is inserted into the joint to perform the diagnostic portion of the procedure [1].
• The superolateral portal is established with an 18-gauge needle through the lesion after pathologic tissue is identified [1].
• A full-radius resector is used to excise the capsule to identify the undersurface of the extensor carpi radialis brevis tendon [1].
• The origin of the extensor carpi radialis brevis is viewed [1].
• A curet and motorized shaver are used to debride the capsule and the pathologic tendinous attachment of the extensor carpi radialis brevis [1].
• The lateral epicondyle is decorticated [1].
• Decortication of the lateral epicondyle and lateral epicondylar ridge can be performed with an arthroscopic burr, handheld instruments, or electrocautery [1].
• A 30-degree arthroscope is adequate to view around the corner for most of the procedure [1].
• A 70-degree arthroscope may be required in rare instances [1].
• Limited internal fixation can be accomplished with cannulated screws when medial capsular injury has not occurred [1].
• The benefit of arthroscopy is outweighed by associated risks in more extensive fractures involving significant soft-tissue injuries [1].
• One should be fully prepared to abort the procedure when visualization is poor or fluid extravasation is significant [1].

Key Evidence

References

[1] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE.