Operation

Before a tennis elbow is operated on, all possible conservative therapy approaches should be exhausted. However, if there is still no improvement in symptoms after 6 – 12 months, further conservative therapy success is unlikely. Then, the indication for surgical treatment is usually given.

This is the case in 10-15% of tennis elbow patients. The operation takes 40 minutes and can be performed on an outpatient basis. Surgery is performed according to 3 different techniques, sometimes also in combination.

Firstly, there is Hohmann’s operation, in which the tendon is detached from the epicondylus (bony protrusion at the elbow); this is also known as a decision tenotomy. The incision is made at right angles to the direction of the tendon. The aim is to relieve the muscle tension through the incision of the tendon and to obtain a slight muscle elongation.

A second technique, the operation according to Wilhelm, pursues the goal of preventing the transmission of pain via the nerves. Therefore, the nerve endings are sclerosed and separated from their innervating muscles. Thus the pain stimulus can no longer be transmitted and processed.

The two previous methods are mostly used as a combined technique. The last operation according to Bosworth stands for the notching of the Ligamentum anulare radii (ring-shaped spoke band). During the course of the operation, the joint capsule is opened and the corresponding joint skin fold is removed, if this was the reason for the pain of a tennis elbow.

In general, the incision is made at the beginning of the operation in the shape of an arc and about 5 cm long on the outside of the elbow. The fat layer and then the muscle fascia can then be cut through. Postoperatively, the tennis elbow must be stabilized with an upper arm cast or bandage for 2 weeks.

Apart from this, there are no restrictions after the operation (e.g. bed rest). Immediately after the operation, the pain is often very severe, so that a drug-based pain therapy is indicated. After about 12 days the stitches can be removed.

The arm does not have to be immobilized afterwards. Full strength is usually regained after 6 weeks. Although it is not absolutely necessary, it is recommended to bandage the arm after an operation in case of future strain.

The overall healing rate is 90%. As with any operation, there are certain risks that should be kept in mind. These include wound healing disorders, bleeding and inflammation.

During wound healing, scar tissue is also formed, which unfortunately irritates the nerve endings after being cut through (operation according to Wilhelm) and can therefore cause pain. Another rare risk and not specific to tennis elbow surgery is the occurrence of a “Complex Regional Pain Syndrome” (CRPS). The phenomenon of irregular healing of soft tissue is also known as Sudeck syndrome and is considered a chronic neurological disease with sensory and motor disorders such as muscle weakness, burning pain at rest and hypersensitivity.

Apart from the surgical method described above, the trend is towards minimally invasive surgery (MIS). Here, in contrast to 5 cm, the incision is only 1 cm long at most, so that the remaining scars are smaller and more inconspicuous. In summary, the operation of a tennis elbow can be classified as uncomplicated and promising healing.

Bandages, braces or cuffs are effective aids to improve the symptoms and to regulate the disturbed muscle tension of a tennis elbow. The use of a bandage affects both the muscles and the tendon and ligament apparatus. The muscles can be stabilized by wearing such a bandage and supported in its work.

Furthermore, the tensile stress changes, especially at the tendons of the corresponding muscles. By the reduction of the tensile stress it comes to a certain extent to the relief and to the relief of the pain. Wearing a bandage has the advantage that the mobility is maintained despite the stabilization, and one is not restricted in everyday life.

The bandages are usually relatively elastic and some have a silicone cushion on the inside and outside. This silicone insert has a punctual, massaging function. At the same time, wearing a bandage prevents inflammation.In addition to the good wearing comfort, stabilization and pain relief, a big plus point of the bandages is that the arm is not completely immobilized and the muscle work is maintained.

In the case of the version of a cast that is no longer used, this was a major disadvantage because the stabilizing effect was always accompanied by muscle atrophy. That is why the forearm plaster splint was never a permanent solution. The bandages, epicondylus braces or cuffs, on the other hand, can be worn indefinitely; it is advisable to wear them for several days for a few hours. The bandage does not have to be taken off during sports activities, but you can benefit from the positive effect on the muscle, tendon and ligament apparatus even under stress. The success of or response to therapy with a bandage can generally vary and depends on the individual condition of the person.