Tennis elbow, also known as lateral epicondylitis, is an elbow injury that occurs as a result of overuse, most commonly from playing racquet sports such as tennis. The pain associated with this condition affects the lateral epicondyle, the area where the forearms' tendons connect with the bony outer portion of the elbow. While tennis elbow typically affects adults aged 30 to 50, anyone who continually stresses their wrists is at a higher risk of developing this condition.
Most of the treatment options for tennis elbow are conservative. However, for the most severe cases, a surgical alternative may be considered. The procedure chosen may be a neuroplasty, which is a surgical decompression of the corresponding nerves in the elbow. There are three major nerves that cross the elbow: the radial, ulnar and median.
When there has been injury or swelling within the joint, scar tissue will sometimes form. As it grows, this scar tissue often puts pressure on one of the nerves, resulting in pain and inflammation. The compression may also be caused by fluid buildup in the elbow, irritation from the movement of the nerve within the joint and physical pressure on the elbow. In addition to playing sports such as tennis that require repetitive movement of the elbow, you have a higher risk of nerve problems in that joint if there are bone spurs or arthritis present, a previous dislocation or fracture there or a cyst within the joint.
The symptoms of tennis elbow affect the inside of the elbow, and may include some of the following:
- Forearm weakness
- Pain when the wrist is extended
- Pain during various activities, such as turning a doorknob
- Pain that spreads from the outside of the elbow into the forearm and wrist
If nerve compression is occurring, you may also experience numbness, a tingling sensation or pain anywhere from the elbow down into the hand. The motor skills of your hand may be affected as well.
Diagnosis and Treatment
Tennis elbow is usually diagnosed by examining the affected elbow and reviewing the patient's medical history. To assess pain, pressure may be applied to the elbow. In some cases, x-rays may be taken to rule out other conditions that may be responsible for causing elbow pain.
In many cases, tennis elbow heals on its own over time. Initial pain can often be managed with rest, ice and over-the-counter painkillers. Cases that don't respond to the aforementioned measures may require additional treatment, in the form of exercises, orthotics or corticosteroids. Severe, persistent cases of tennis elbow may require surgery; however, surgery is only necessary for about ten percent of those suffering from tennis elbow. Your doctor will develop a customized treatment plan based on your individual condition.
If the symptoms of tennis elbow remain present six months to a year after conservative therapies were started, a surgical treatment such as neuroplasty may be considered. This procedure is performed to take pressure off the sensitive nerves within the elbow that have been the source of the pain.
During a neuroplasty, the surgeon will remove all scar tissue that has formed within the joint as well as any damaged muscle that is found. Any bone spurs on the lateral epicondyle will be smoothed down. A small hole will then be drilled into the bone to relieve the nerve pressure and promote healing.
The neuroplasty may be performed as an open surgery, in which the incision is made over the elbow joint and the surgeon has a view of the entire joint. In other cases, it may be decided to perform an arthroscopic neuroplasty, in which tiny incisions are made around the joint and a lighted camera and miniature instruments are used. In both cases, it is generally an outpatient procedure.
Risks of Neuroplasty
Although neuroplasty is considered a safe procedure, all forms of surgery pose certain risks. The risks typically associated with neuroplasty include infection, nerve damage, weakness in the joint, loss of flexibility, blood vessel injury and healing complications.
Recovery from Neuroplasty
Immediately after the procedure, the arm is immobilized in a splint. Approximately one week after neuroplasty, the splint and sutures are removed and a physical therapy program begins to strengthen the elbow again and promote flexibility. After four to six months, most patients can resume athletic activities. Neuroplasty has a very high success rate in alleviating the symptoms of tennis elbow.
Questions? If you would like more information about Neuroplasty or to schedule an appointment, feel free to fill out our convenient contact form or call our office at (212) 606-1855.