Sports surgery - tennis elbow

Definition of tennis elbow:

In sports surgery, tennis elbow or lateral epicondylitis is often found in amateur athletes but not only in tennis. This tendonitis is also found in many other sports. This sports pathology is chronic inflammation of the muscles in the forearm’s external compartment, namely the extensor carpi radialis longus and extensor carpi radialis brevis of the elbow. The training plan is often a factor.

Although Tennis Elbow tendonitis is more frequent in tennis players, it is often found in many other sports.In this sports pathology, the pain is often located on the external aspect of the elbow

 

Treatment is primarily nonsurgical, combining an ergotherapeutic assessment, anti-inflammatory treatment, massaging, injections, a nocturnal resting splint.

Video of tennis elbow treatment:

Video of arthroscopic sports surgery for elbow tendonitis / Toulouse specialist

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.

Diagnosis of tennis elbow:

This coronal cross-sectional MRI image of the elbow shows signal anomaly at the epicondylitis’ proximal insertion, on the elbow’s lateral side, associated with a partial rupture, which will be completely severed during the procedure.

Elbow tendonitis in the athlete, elbow MRI showing abnormal signal at the lateral epicondyles, ToulouseLateral epicondylitis in the athlete, MRI of the elbow showing partial detachment of the lateral epicondyles, Toulouse

 

Surgical treatment for tennis elbow:

The surgery is performed on an outpatient basis under regional anaesthesia, with the patient comfortably positioned on his or her side.
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, with the humero-radial joint space; we can see a lesion to the capsule that is present in most cases and which indicates that there is an extensive rupture of the extensor carpi radialis.

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

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

Arthroscopy of elbow tendonitis, gradual disinsertion of the lateral epicondyles, ToulouseArthroscopy of elbow tendonitis, complete disinsertion of the lateral epicondyles, Toulouse

Once surgery is finished, the two incisions are closed using an absorbable stitch.

Recovery after tennis elbow surgery

A wrist splint will be necessary for 15 days.
Daily activities can resume after 3 weeks.

Arthroscopy of elbow tendonitis, bespoke post-operative splint, ToulouseArthroscopy of elbow tendonitis, sporting resumes after 2 to 3 months