Patients › Elbow
Tennis Elbow Release
Tennis elbow release surgery — for persistent pain despite physiotherapy and other conservative treatments.
Why this operation has been suggested¶
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For long-standing problems we usually try non-operative care first. We consider surgery when that has not given enough improvement.
Tennis elbow is wear-and-tear arthritis of the elbow tendon. Most people recover within 6 months without surgery. About 90% of people with untreated tennis elbow achieve symptom resolution at 1 year. Surgery is for the small percentage who do not respond to non-operative approaches. In these cases, surgery provides near 90% satisfaction rates. The operation aims to relieve pain and restore function.
Before the operation¶
If you have other medical conditions, you may need blood tests or a review with the anaesthetist before surgery. Please fast for seven hours before your procedure and stop taking specific medications only as directed by your surgeon. Arrange for a responsible adult to drive you home and stay with you for the first night. Wear loose, comfortable clothing that allows easy access to your arm. Bring a complete list of all current medications and supplements. This preparation helps us keep you safe and supports a smooth start to your recovery journey.
On the day¶
You present to the hospital's surgical admissions unit for check-in and preparation. You meet the anaesthetist to discuss your care. 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.
You are then taken into the operating theatre, where the operation is performed. Afterward, you wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.
What the operation involves¶
Your surgeon performs this procedure through a single cut on the outer side of your elbow, directly over the bony bump known as the lateral epicondyle. This approach allows direct access to the affected tendon without using scopes or keyhole incisions.
Inside, your surgeon identifies the damaged portion of the extensor carpi radialis brevis tendon. This is the tendon that connects your forearm muscles to the elbow bone and often becomes frayed or degenerated in tennis elbow. The surgeon removes this worn-out tissue to clear the source of pain. The remaining healthy tendon is then reattached to the bone using small anchors. These anchors act like tiny screws to hold the tendon securely in place while it heals.
The cut is closed with stitches, and a dressing is applied to protect the area. This focused approach aims to restore function by repairing the specific tissue damage causing your symptoms.
After the operation¶
You will wake up in the recovery ward. We manage pain with standard medication. Your elbow will have a soft dressing. This is usually a day case, so you can expect to go home the same day, although occasionally patients stay overnight. You must have someone stay with you for the first 24 hours. You can move your fingers and wrist gently. We do not use rigid braces or casts for this operation. Most patients return to driving within two to three weeks, once any post-op splint is off and pain has settled enough to hold the wheel and react quickly. Patients in a splint must NOT drive. See Driving after upper-limb surgery for more details.
Recovery¶
You will notice some swelling and soreness in the first few days. This is normal. Your surgeon will provide a soft dressing to protect the area. You do not need a rigid splint, cast, or brace. Keep your arm elevated when resting to help reduce swelling. Most people find sleeping slightly propped up more comfortable at night.
As the swelling settles, you will begin gentle movements. Your surgeon and our hand therapist will guide you through these steps. We work with Ruby Doolan at Extend Rehabilitation for your hand therapy. These exercises focus on restoring movement and strength. You will start with simple motions and gradually increase activity as pain allows. Avoid heavy lifting or repetitive gripping until your surgeon clears you.
Daily tasks like dressing and eating are usually manageable with one hand. You may feel stiff in the morning, but this eases as you move. Pain should gradually decrease as healing progresses. You can return to driving once any post-op splint is off and you can hold the wheel and react quickly. This typically takes two to three weeks, but depends on your comfort.
Recovery varies between individuals. Your timeline may differ; your surgeon and hand therapist will guide you based on how you heal. Focus on consistent, gentle progress rather than speed.
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.
Infection You might notice the skin around your elbow becoming red, warm, or swollen. You may see pus or feel a general sense of being unwell with a fever. If you see signs of spreading redness or feel hot, call the clinic right away. You may need to go to the emergency department if the infection seems serious.
Stiffness and Limited Movement Some people find their elbow feels tight or hard to bend after surgery. You might notice a slight limit in how far you can straighten or bend your arm. This can feel like a physical block or just general tightness. Bring this up at your next review so we can adjust your exercises.
Bone Growth in Soft Tissue In rare cases, bone can form in the soft tissue around the elbow. This is called heterotopic ossification. You might feel a hard lump under the skin or notice increased pain when moving your arm. Tell your surgeon if you feel a new, hard mass near the surgical site.
Need for Further Surgery Very rarely, the initial treatment may not work, and you might need another operation. This is known as revision surgery. You might feel that your pain has returned or worsened after a period of improvement. If your symptoms do not improve as expected, discuss this with your surgeon to see if further steps are needed.
The complications table on this page lists typical rates if you want the specifics.
When to call us¶
Call us if you have fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling or shortness of breath. Seek urgent care for loss of sensation or inability to move the limb. These signs need immediate assessment to keep your recovery on track.
Where to read more¶
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Tennis Elbow page.
Where to read more about the condition¶
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Tennis Elbow page.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
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].
References¶
[1] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE.