Elbow epicondylitis is the inflammation of the tendons that attach to the humerus (upper arm bone) at the bony prominences known as epicondyles. Epicondylitis results from overuse of the joint and microtears in the tendons that lead to pain and stiffness. The most common forms of epicondylitis in the elbow are lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow). Surgical treatment is recommended if symptoms are not alleviated with nonoperative treatment options.
In a lateral epicondylitis surgery, a tendon release of the extensor carpi radialis brevis (extensor tendon in the forearm) is performed to reduce the tension on the tendon, and any degenerative tissue at the tendon insertion is excised to facilitate healing of the diseased tissue. This surgery can be performed via an open or arthroscopic approach. Any loose bodies or bone spurs identified during the procedure are also removed to reduce irritation in the elbow. A brace and physical therapy are recommended after the procedure to obtain a good result and to allow return to full activity.
In a medial epicondylitis surgery, an incision is made on the inside of the elbow. The procedure involves debridement (removal) of any damaged tissue from the flexor carpi radialis and pronator teres (flexor tendons of the forearm). In some cases, the flexor-pronator group is reattached to the medial epicondyle to restore strength and reduce inflammation. The medial epicondyle and flexor tendons attached to it are located near the ulnar nerve in the cubital tunnel in the elbow joint. If the inflammation from the medial epicondylitis also causes ulnar nerve compression, an ulnar nerve decompression can also be performed during the medial epicondylitis repair. After surgery, the elbow may be immobilized for 1-2 weeks before starting physical therapy. Intensive and dedicated physical therapy according to specified protocols is essential to obtain a good result and to allow return to full activity after 3-4 months.