Tennis Elbow: When Is Surgery the Best Option?

Tennis elbow is the layperson’s name for a condition called lateral epicondylitis. If you have tennis elbow, your extensor carpi radialis brevis — the tendon that anchors your forearm muscle to the outside of your elbow — is weak, injured, or inflamed. 

The extensor carpi radialis brevis helps extend and stabilize your wrist. It also allows you to flex your palm upward. 

You can damage your extensor carpi radialis brevis through repetitive motions, particularly those that require force, such as hitting backhand with a tennis racket. However, anyone who regularly uses their wrists and arms in their job or sport is at risk for tennis elbow.

David Lintner, MD, is a sports medicine specialist who diagnoses and treats athletes and non-athletes with tennis elbow at Houston Methodist Orthopedics & Sports Medicine Baytown, Texas, and Houston, Texas. If you’re having trouble using your elbow without pain, you may wonder if surgery is your best option. The following questions help you decide.

Have you had symptoms for at least 6-12 months?

Most cases of tennis elbow resolve on their own within a year, even without treatment. Symptoms of tennis elbow typically include:

• Burning or aching on outside of the elbow
• Pain on the outside of the elbow
• Trouble or pain when gripping, turning, or lifting objects
• Pain that travels down the forearm
• Pain when moving the elbow

You don’t have to wait for a year to begin treatment, however. If your elbow hurts or if your grip is weak, Dr. Lintner thoroughly examines and diagnoses your condition and customizes a treatment plan for you. Only after all less invasive treatments have failed should you consider surgery.

Have you tried rest and lifestyle modifications?

Tennis elbow isn’t usually an acute (i.e., sudden) injury. In most cases, it develops so gradually that you may not even remember exactly when your symptoms started. However, if you are experiencing symptoms such as burning or weakness in your wrist and elbow, or if you can’t play your sport or perform daily activities without pain, first rest your elbow.

Dr. Lintner helps you take the stress off your tendon with a brace/strap blunts the force coming from your grip up to the elbow. This strap should be worn on the fleshy part of your forearm belo the elbow ( NOT ON THE SORE SPOT). He may also recommend changes in the tools you use, such as switching to a lighter or smaller tennis racket. 

Have you tried physical therapy?

Physical therapy helps calm and strengthen your damaged tendon. You may be given a series of exercises that gently stretch the tendon and increase its strength. You may also receive supportive treatments, such as ultrasound and heat therapy.

Have you tried medications and injections?

Anti-inflammatory medications, such as NSAIDs, alleviate the pain and swelling associated with tennis elbow. A topical NSAID ( VOLTAREN gel) can work wonders and avoid passing through your kidneys or stomach. If you don’t experience relief with over-the-counter pain medications and NSAIDs, Dr. Lintner may recommend corticosteroid injections.

Dr. Lintner injects the steroids directly into your inflamed tendon. They subdue the swelling and eliminate the pain. Steroid injections may keep you comfortable for months as you rehabilitate your tendon and adopt modifications to your technique that will protect your elbow as it heals. 

Have you tried PRP?

Platelet-rich plasma (PRP) is a relatively new treatment that’s been adopted by some of your favorite celebrity athletes, including Tiger Woods. Dr. Lintner and his team prepare a healing serum from your own blood that they inject directly into the site of your injury.

PRP is a type of orthobiologic treatment, which uses the power of the human body to heal itself. Platelets carry enzymes and chemicals that stimulate healing. When our team injects a platelet-rich serum of your own blood into your injured tendon, it helps your body build new blood vessels to nourish the site and accelerate the healing process.

Dr. Lintner may also recommend stem cell treatments — another type of orthobiologic therapy. As with PRP, injected stem cells provide your body with an abundance of the ingredients it naturally uses in the healing process. The extra stem cells simply help you heal and rebuild more quickly. Note that insurance doesn't cover PRP or stem cell treatments.

Have you tried everything?

If none of the lifestyle adjustments and noninvasive treatments have helped you, you may be a candidate for surgery. However, most people respond to lifestyle adjustments, physical therapy, medications, or orthobiologic treatments.

Dr. Lintner only recommends surgery if no other options are available to you. He’s an expert at reconstructing the extensor carpi radialis brevis with minimally invasive surgery. During your recovery period, you undergo physical therapy to help strengthen the tendon and keep it flexible, too. 

If you have tennis elbow that’s interfering with your game, job, life, or comfort, contact our office nearest you in Houston, Texas, or Baytown, Texas. You can phone our friendly team or schedule an appointment online.