Elbow > Tennis Elbow > Treatments

   Surgical Debridement

Preparing for Surgery

The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your outpatient (ambulatory) surgery. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your elbow may be shaved, though this is not always necessary. You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose, oversized shirt that will fit comfortably over an elbow bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Debridement surgery usually takes about 30 to 45 minutes to perform. Unhealthy tissue is removed from the tendon connecting your forearm muscles to the outside of your elbow. This also stimulates blood flow to the tendon, which helps it to heal properly.

   You will either be put under general anesthesia or have your arm numbed with a regional anesthesia that is injected into your shoulder.

   Physicians make a one- to three-inch incision in the skin over the bump on the outside of the elbow. (Some surgeons have begun performing debridement surgery arthroscopically, but this technique has not yet come into widespread use.)

   The incision exposes the damaged tendon that is usually visibly degenerated, discolored, or torn.

   The surgeon removes (debrides) the damaged portion. Sometimes the surgeon also removes part of the bony bump on the side of the elbow (lateral epicondyle) and may need to reattach surrounding tendon to the bone.

   The remaining healthy tendon tissue is sewn together.

   Incisions are stitched with either absorbable or nonabsorbable sutures and you are taken to the recovery room.

Recovery Room

When you awaken in the recovery room following surgery, your elbow is usually wrapped in gauze, bandaged, and covered with an ice pack. Some surgeons place your arm in a posterior splint for seven to 14 days after surgery. This is a sheet of plaster wrapped in cotton and positioned along the back of your arm that keeps your elbow bent at 90 degrees. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for pain medicine. You may initially have significant pain in the elbow and moving your wrist also may cause pain. You should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital. The majority of patients leave the hospital after two or three hours. As soon as you are fully awakened, you are usually allowed to go home. You will be unable to drive a car, so be sure to have arranged a ride home.

Depending on much you rely on the injured hand, you may be able to wuickly return to work after debridement surgery. Doctors strongly recommend that you avoid any movement that strains your wrist. In general, you want to avoid movements and activities that cause the forearm muscles to flex repeatedly. Physicians generally recommend that you avoid picking up heavy objects until all the pain has gone away. You should usually avoid lifting objects that weigh over five pounds for four to six weeks. After surgery, you should learn to pick things up with your palm facing up, instead of down, to relieve stress on the wrist extensor muscles in your forearm. Here is what you can expect and how you can cope after surgery:

   You will likely feel pain or discomfort for the first few days, and you will be given pain medications as needed. Many patients may be given a narcotic painkiller.

   There may be some minor drainage on the bandage since fluid may have accumulated during the surgery. Some blood may show through the bandage during the first 24 hours.

   As much as possible, you should keep your elbow elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your arm. Icing your elbow for 20 or 30 minutes a few times a day during the first two days after surgery also will reduce pain.

Rehabilitation

Your doctor and physical therapist will most likely prescribe several exercises to stretch the arm muscles and build strength around the elbow. This helps relieve stress to the extensor tendon that attaches the forearm muscle to the bony bump on the outside of the elbow. Most people do not begin exercises until swelling and pain has been reduced. Your physician and physical therapist will decide on a custom rehab program that varies depending on your body type, level of involvement in activities, and severity of tennis elbow. It may take three to six months to return to activities. In general, rehabilitation of the elbow can be broken into four phases:

   Immediate motion ­ Gentle stretching with the aid of a physical therapist can help reestablish a pain-free range of motion, reduce pain and inflammation, and prevent your muscles from weakening due to inactivity.

   Intermediate exercise ­ The goals are to increase elbow mobility, improve strength and endurance, and enhance your muscular control around the elbow with light exercises. You should have full range of motion and feel little pain in your elbow before advancing to this stage of rehab.

   Advanced strengthening ­ Once you have returned to about 70 percent of your own healthy arm strength, you can begin exercises to build total arm strength. If you remain pain-free, you can start to test your power and endurance with more complicated exercises. The goal is to increase your coordination to prepare you for activities.

   Return to activities ­ Your physical therapist can make sure you have a full and pain free range of motion before your rehab is finished. Progressive functional drills, which teach you proper technique, are usually the final phase of rehab.

Rehabilitating tennis elbow can be difficult because so many daily activities, like turning doorknobs, can cause pain during the first few weeks. Try to be patient and follow your physical therapists instructions.

Using proper form during activities, whether they are sports- or work-related, can help prevent the recurrence of tennis elbow. Your physical therapist can teach you proper posture and technique that can lessen the strain on your elbow's tendons. An important prevention technique is to learn to lift objects with your palm facing up. The everyday strain of lifting objects with the palm down puts extra stress on your outside forearm muscles. Be sure to gradually increase the intensity of manual activities. For example, avoid playing several hours of tennis if you have not played for months, or taking on a big carpentry project when you have not picked up your tools for a while. With a chronic overuse injury like tennis elbow, you may strain your tendon one day but not feel significant pain until a few days later. To prevent reinjury, it is important to know your limits beforehand and be cautious when repeatedly using your wrist during activities. When you have to use your wrist and elbow, try to ice the outside of your elbow after activities. Physicians generally recommend that you use tools and sports equipment that is properly sized to fit your hand. If your doctor prescribed a brace, be sure to wear it during activities. In general, you should make the stretching and strengthening you learned in rehab part of your regular exercise routine.

Treatment Introduction

Surgery to treat tennis elbow is rare. However, if you have been unable to heal tennis elbow after about a year of non-surgical treatment, including a supervised rehabilitation program, you may be a candidate for surgery. Most patients feel a dramatic improvement in tennis elbow symptoms after a debridement procedure, but often have a slight residual weakness in the muscles that bend the wrist backward. Debridement basically removes damaged tissue from the tendon that connects your forearm muscles to the bony bump (lateral epicondyle) on the outside of your elbow. It stimulates blood flow to the tendon, which can help healthy tissue replace degenerated or torn tissue.