Orthopedics-Online

Operation of a tennis elbow

When should a tennis elbow be operated?

For tennis elbow, surgery is only useful as therapy in some cases.
First of all, treatment should always start conservatively. Only if after 6 months of conservative therapy there has always been no significant improvement in the symptoms or the condition of the person concerned has even worsened, an operation should be considered.
From the point of view of Dr. Nicolas Gumpert - author of this topic - surgery is only the last resort, as very effective conservative ways are now available.

Of course, there are other points that influence the decision as to whether the operation is actually carried out, especially the patient's individual level of suffering. Ultimately, the aim of the operation is to achieve permanent relief of the chronically tense muscles and to give the person concerned back their unrestricted, pain-free freedom of movement.

Appointment with a tennis elbow specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".

As a former performance-oriented tennis player, I specialized early on in the conservative treatment of chronic tennis elbow.
In the last few years I have successfully treated several thousand tennis arms.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert.

Outpatient or inpatient surgery

As a rule, a Tennis elbow surgery outpatient This means that the person concerned does not have to be admitted to the hospital as an inpatient.
Also with the Tennis elbow surgery Minimally invasive techniques are developing, so that tennis elbow surgery can now be performed under local anesthesia.

Surgical techniques

There are basically three different procedures for operating on a tennis elbow:

The standard procedures are the Hohmann operation
and
the operation according to Wilhelm
The latest technology is the minimally invasive operation according to Hohmann (Burke)

Operation according to Hohmann

In the Hohmann operation, the muscles or tendons that arise in the area of the elbow (on the humerus) are carefully detached.
The ligaments that attach in this area are also carefully examined to remove any bony changes that may also contribute to the symptoms of a tennis elbow.

Operation according to Wilhelm

In the Wilhelm operation, the small nerves that supply the elbow with sensitivity are severed and then obliterated.
This is known as “denervation”. Often these two surgical techniques (OP according to Hohmann-Wilhelm) are combined.

Surgical technique

The incision size is usually around 4 to 5 cm and the entire procedure takes around 20 - 45 minutes.
After such an operation, the affected arm must be immobilized for a while. This is usually ensured by placing a plaster splint on the patient, which he or she has to wear for about two weeks. A plaster splint is not mandatory, however.
Then slowly start moving the elbow in the joint again.
Depending on the healing process, in some cases it is advisable to include professional physiotherapy in the aftercare.

Minimally invasive surgery

Minimally invasive surgery differs from the two above in a number of important ways.
The procedure can be completed within 5 minutes and is always carried out on an outpatient basis, although there are not yet many medical practices in Germany that carry out this method.
Here the skin incision is less than 1cm long. On the one hand, this lowers the risk of infections and scars. On the other hand, the overview for the orthopedic surgeon is also less and some ossified areas that are a little further away from the place of origin of the muscles may be overlooked.
The greatest advantage of this type of surgery is that the patient is immediately mobile again. A pressure bandage only has to be worn on the first day after the operation. The fact that the arm is hardly immobilized means that less scar tissue forms and the loss of function for most of those affected is limited to postoperative pain, which cannot be avoided after any type of operation and, depending on the physical condition, again within 3 to 5 days should have subsided.
Complete freedom from pain can be expected after 3 weeks to 6 months, depending on the severity of the tennis elbow and the healing process. The chances of success with this surgical technique is almost 90%.

Relapse / relapse

Relapses / recurrences after tennis elbow surgery are rare and can then be tackled again conservatively and / or surgically.

anesthesia

With these two conventional procedures (OP according to Hohmann / OP according to Wilhelm) the Operation under anesthesia.
Depending on the case, this can be a general anesthetic, one Regional anesthesia or one Plexus anesthesia (Anesthesia in the armpit).

The minimally invasive form can be performed under local anesthesia.

Operational risks

Risks of this surgery are mainly based on the relatively large incision and the associated high probability of infecting the wound postoperatively or of causing pronounced scarring, which impairs movement and cosmetics in the long term.
A complete healing is achieved in about 80% of the cases with open procedures (Hohmann-OP / Wilhelm-OP).

Aftercare

The time after the operation is also important for healing.

Correct and consistent follow-up treatment is of great importance for the success of the operation. After the operation, the elbow is in one for about 8-14 days, depending on the severity Upper arm plaster splint immobilized. The patient receives precise information on this from his treating doctor. It also determines after how many days the plaster splint can be removed and the stitches pulled. Additionally be anti-inflammatory and pain reliever drugs prescribed. To avoid possible complications, it is advisable to move your fingers under the cast. This prevents Thrombosis and swelling, while promoting blood circulation. After 2 weeks, the load can be increased slowly. Through a postoperative physiotherapy the patient can use adapted exercises to strengthen his strength and flexibility and restore the full function of the arm. The exercises should be done regularly and correctly at home. It is important to ensure that they are not carried out against the pain, but that they correspond to your own load capacity. Follow-up treatment should be carried out regularly, patiently and calmly so that it has a lasting effect and prevents the problem from recurring. The Chances of success on complete healing are included 80-90%.

Stretching exercises after an operation

In an operation on tennis elbow, the affected tendon and muscle attachments are usually separated from the protruding bone. After immobilization for 1-2 weeks, the arm should be moved again. Careful stretching exercises are also part of the physiotherapeutic follow-up treatment after an operation on a tennis elbow. These can prevent the tendon from growing again on the elbow and thus prevent the tennis elbow from recurring. The intensity of the exercises can be determined together with the treating physiotherapist and can also be carried out independently at home.

Read a lot more information on this topic at: Stretching exercises for a tennis elbow

Pain While Stretching - Carry On?

It often happens that pain occurs during stretching exercises and exercises with the Theraband.
At the beginning of the therapy, a slight pain should initiate the end of the respective stretching exercise. Over time, stretching can be carried out to the point of pain. Whenever the stretching exercises can be performed painlessly again, the repetition of the exercises during the day can be increased. However, this should be done in consultation with the attending physician or the supervising physiotherapist.

Also read on this topic: Tennis elbow pain

Sick leave

Sick leave certainly makes sense as long as the patient is wearing a plaster splint and initially still suffers from postoperative stress pain.
During the inpatient stay in the hospital, the patient can receive a certificate that he can submit to his employer. Follow-up care and controls are usually carried out by the resident doctor who also gave the introduction and made the indication for an operation. A sick leave will be written out from him after the hospital stay. The sick leave depends on the type of operation, its course and the job that the person concerned normally does. It can last from a few days to months and can be extended if necessary.
As a rule, with minimally invasive technology and office work, you are on sick leave for 14 days.

Supinatorlous syndrome

Another important point is that before tennis elbow surgery always the so-called Supinatorlous syndrome should be excluded. This syndrome causes pain that is very similar to that of a tennis elbow and is due to an outgoing branch of a nerve (Ramus superficialis of Radial nerve) is pinched in the area of the muscle arcade of the supinator muscle in the forearm area.
If these two clinical pictures are confused, tennis elbow surgery will not provide pain relief. Often, however, both diseases are present at the same time, and tennis elbow surgery can then be combined with the open surgery that is common in supinatorlogic syndrome.