People recovering from tennis elbow surgery are generally able to return to normal daily activities in two to six weeks; return to work within three to 12 weeks; and return to sports in four to six months.
Of course, recovery times vary based on many factors. Some of these factors may include your age, health, and chronicity of the problem (i.e. how long it has been bothering you). The type of work and sports you are returning to may also impact how quickly you can return to them.
It is important to speak with your orthopedic surgeon to discuss the specifics regarding the recovery process.
What is Tennis elbow? (Anatomy & Physiology)
To fully understand what tennis elbow is, it will be helpful to review the anatomy of the elbow. It will also be helpful to define a few terms.
“Tennis elbow” is the common name for a condition called lateral epicondylitis. Lateral epicondylitis refers to a tendinosis or tendinitis of the wrist extensor muscles that originate from the outer elbow. In other words, excessive, repeated use of the extensor muscles results in damage to and consequent degeneration of their tendons (specifically, of the extensor carpi radialis brevis tendon or ECRB) that attaches to the lateral epicondylar region of the distal humerus. These muscles allow you to extend your wrist (bring your wrist backwards).
Let’s define a few terms to help us understand the anatomy and physiology of lateral epicondylitis, or “tennis elbow”:
- Tendon: A tendon is a strong tissue that connects muscles to bones.
- Ligament: A ligament is a tissue that connects bones to bones.
- Lateral epicondyle: Lateral refers the part of the body that is further away from the midline of your body (i.e. the lateral elbow is the outer part of the elbow). An epicondyle is a bony prominence. There is one on either side of the end of the humerus. The lateral epicondyle is where the extensor muscles of the wrist originate from.
- Humerus: The humerus is the name of the upper arm bone, connecting your shoulder to your elbow.
- Radius: The radius is the larger of the two forearm bones.
- Ulna: The ulna is the smaller of the two forearm bones. It connects the pinky side of your wrist to the medial side (inner part) of the humerus.
- Extensor carpi radialis brevis (ECRB) muscle: This is the name of one of the wrist extensor muscles that originates from the lateral epicondyle. This is the muscle that is most commonly involved in “tennis elbow.”
- Tendinitis: The -itis- ending on words means inflammation. In this case we are referring to inflammation of a tendon.
- Tendinosis: The -osis- ending on words refers to any abnormal condition.
What are the Symptoms of Tennis Elbow?
Tennis elbow is associated with pain over the outside of the elbow. It is worse with gripping activities, wrist extension (e.g. a backhand in tennis), and better with rest. You may feel that your grip strength is weak.
Who is at risk?
Tennis elbow, or lateral epicondylitis is the most common cause of elbow symptoms. It is most common in individuals between the ages of 35 and 50 years of age. It affects about 2% of adults yearly.
As its name suggests, tennis players are commonly at risk for this musculoskeletal condition. An estimated 50% of tennis players will suffer from pain, weakness, or discomfort from lateral epicondylitis.
Improper swing technique and use of an inappropriately sized tennis racquet are all associated with a significant increase in the risk of developing tennis elbow.
However, tennis players are not the only ones at risk of developing “tennis elbow.” Any activity, sport, task, or job that requires repetitive extension (bending back) of the wrist increases the risk of developing lateral epicondylitis. Other jobs or activities where repetitive wrist extension is common may include playing the violin, painting, decorating, or certain manual labor jobs (such as hammering, etc.).
Tennis elbow is entirely different from golfers elbow. Golfers may be at risk of developing injury to the tendons on the inside part of the elbow–this is called “golfer’s elbow.
How can I prevent it?
For tennis players, things that can be done to prevent “tennis elbow” include:
- Selecting a properly sized and weighted tennis racquet
- Learning and practicing correct form and technique
- Stretching and warming up forearm muscles before and after playing tennis
For others who find themselves in jobs or other daily activities that put them at risk of developing tennis elbow, stretching and strengthening of the wrist extensor muscles on a daily basis may help to prevent it.
How can I treat tennis elbow?
Thankfully, about 90% of the time tennis elbow can be treated without surgery. The frustrating part, however, is that it can you a long time to recover from tennis elbow (typically 9 months or more, because it is hard not to use the wrist!) If you think you are suffering from pain or weakness due to tennis elbow, talk to your doctor about different treatments.
Different treatments that may help:
- Physical therapy & stretching exercises
- Over the counter anti-inflammatory medications (acetaminophen or ibuprofen)
- A counterforce strap
- Platelet rich plasma injections
- Surgery or other procedures – in severe cases
Non-surgical treatments should always be tried prior to surgery as “tennis elbow” can most often be corrected without surgery. Although surgery is successful about 90% of the time, it is not always needed.
- Ultrasonic tenotomy (TENEX procedure)- Doctors insert a special needle into the affected tendon using ultrasound technology. The needle produces vibrations that liquify the tendon so that it can be extracted through the needle.
- Injections- More recently, there has been an increased interest in the use of injectable platelet rich plasma (PRP). Simply put, PRP consists of healing factors that are harvested from your own blood. The idea behind PRP is that it stimulates regeneration of damaged tissues. The injection of platelet-rich plasma (PRP) into the ECRB tendon has been shown to help in recovery.
In the past, steroid injections have been used for the treatment of tennis elbow. More recently, it has actually been shown that these injections may potentially worsen the condition.
What does tennis elbow surgery mean for me?
What happens during the surgery?
Different surgical techniques exist for the treatment of lateral epicondylitis. Generally, the surgeon makes a small incision over the lateral epicondyle. He/she then locates the affected tendon and removes a portion of the damaged tendon and / or releases the attachment of the damaged tendon (ECRB) from the lateral epicondyle. The tendon may then be repaired in a lengthened position. The incision is then typically closed with sutures and covered with a surgical bandage.
If you are considering surgery for the treatment of your tennis elbow, it is best to talk to your surgeon about his / her surgical technique.
What does recovery look like?
Your arm may be placed into a splint following surgery to immobilize it for a short period of time. If a splint is used, you will not be able to move your elbow during this part of the recovery period.
Physical therapy will be a part of your recovery. When your surgeon decides you are ready, you will begin to stretch, move, and do exercises to strengthen the affected muscles.
People recovering from tennis elbow surgery are generally able to return to normal daily activities in two to six weeks; return to work within three to twelve weeks, and return to sports in four to six months.
Speak with your surgeon to discuss what surgical recovery may look like for you.
Tips for recovering at home
The most important step to take in your recovery is to make sure that you follow the directions given to you by your surgeon and physical therapist.
If you are doing something that hurts the affected elbow, take a break and rest.
Ice can help to reduce both pain and swelling. Icing 10-20 minutes every 1-2 hours during the first few days may be helpful. Remember to put a washcloth or piece of cloth between the ice and your skin so you don’t hurt yourself.
Note that the information in this article is purely informative and should never be used in place of the advice of your treating physicians.