Lateral epicondylitis –Tennis Elbow

Definition of tennis elbow:

Lateral epicondylitis or tennis elbow is tendonitis of the elbow that affects the extensor carpi radialis brevis wrist muscles (ECRB).
It is a chronic condition that often occurs in a specific professional or sporting context. Treatment is primarily nonsurgical, combining an ergotherapeutic assessment, anti-inflammatory treatment, massaging, injections, a nocturnal resting splint.

Video of elbow tendonitis treatment:

Elbow surgery video showing arthroscopic tendonitis treatment / Toulouse specialist

Surgical treatment of elbow tendonitis:

It is currently recommended that surgery should only be performed if the various medical options fail repeatedly.  

It is very important to be aware that surgery is only a therapeutic alternative and that it is not more efficacious than medical treatment.
Recent studies seem to show that surgery on elbow tendonitis is unsuccessful when the condition is occupational.
When surgery is nevertheless chosen, arthroscopy does minimize scarring and recovery time but does not improve efficacy.

This coronal cross-sectional MRI image shows abnormal signal at the proximal insertion of the lateral epicondyles, lateral to the elbow, associated with a partial rupture, which will be completed during the procedure.

Elbow tendonitis, elbow MRI showing abnormal signal at the lateral epicondyles, ToulouseElbow tendonitis, elbow MRI showing partial tear of the lateral epicondyles, Toulouse

This wrist surgery is specialized surgery, it is performed on an outpatient basis, under regional anaesthesia, with the patient in the lateral decubitus position.
Only two 5-mm incisions are necessary, one antero-medial for optics, one anterolateral for instruments.
Shown below is the lateral aspect of the elbow joint, with the humero-radial joint space; a lesion to the capsule can be seen, which is present in most cases and indicates that there is an extensive rupture of the extensor carpi radialis.

Arthroscopic elbow surgery, operative setup, ToulouseArthroscopic elbow surgery, radial capsular wound, Toulouse

The treatment consists in detaching the muscle at the enthesis; as surgery proceeds, care is taken to ensure that release is complete, without going beyond the proximal insertion of the lateral collateral ligament.

Arthroscopy of elbow tendonitis, gradual detachment of the lateral epicondyles, ToulouseArthroscopy of elbow tendonitis, complete disinsertion of the lateral epicondyles, Toulouse<br />


 

Recovery after surgery on elbow tendinitis

Once arthroscopic surgery is finished, the two incisions are closed using an absorbable suture.
A wrist splint will be necessary at 15 days.
Daily activities can resume at 3 weeks.

Arthroscopy of elbow tendonitis, bespoke post-operative splint, ToulouseArthroscopy of elbow tendonitis, forceful activities resume after 2 to 3 months