When should tennis elbow be operated on?
For tennis elbow, surgery as a therapy is only useful in some cases. First of all, the treatment should always be started conservatively. Only if after 6 months of conservative therapy there is always no significant improvement in symptoms or the condition of the affected person has even worsened, should surgery be considered.
From our point of view, surgery is only the last resort, as very effective conservative methods are now available. However, there are of course other factors that influence the decision whether or not to have the operation, especially the individual suffering of the patient. The ultimate goal of the operation is to achieve permanent relief of the chronically tense musculature and to restore the patient’s unrestricted, pain-free freedom of movement.
Operation outpatient or inpatient
As a rule, tennis elbow surgery can be performed on an outpatient basis, i.e. the patient does not need to be admitted to hospital as an inpatient. Minimally invasive techniques are also being developed for tennis elbow surgery, so that tennis elbow surgery can now be performed under local anesthesia.
Surgical Techniques
In principle, there are three different procedures for operating on tennis elbow:
- The standard procedures are the Hohmann and
- The operation according to Wilhelm
- The latest technique is the minimally invasive surgery according to Hohmann (Burke)
Operation according to Hohmann
In Hohmann’s operation, the muscles or tendon that originate in the area of the elbow (at the humerus) are carefully detached. The ligaments that start in this area are also closely examined in order to remove any bony changes that may have contributed to the symptoms of tennis elbow.
Operation according to Wilhelm
In the operation according to Wilhelm, the small nerves that supply the elbow sensitively are severed and then sclerosed. This is called “denervation”. These two surgical techniques (Hohmann-Wilhelm’s operation) are often combined.
The incision size is usually about 4 to 5 cm and the whole procedure takes about 20 – 45 minutes. After such an operation, the affected arm must be immobilized for a while. This is usually ensured by placing a plaster splint on the patient, which he or she must wear for about two weeks.
However, a plaster splint is not mandatory. Afterwards, the patient should slowly begin to move the elbow in the joint again. Depending on the healing process, it is sometimes advisable to include professional physiotherapy in the aftercare.