The Importance of Getting a Second Opinion for Surgery

Back in January 2012 I decided to get fit again. To that end, I started playing squash like there was no tomorrow. 5 days a week, sometimes as long as an 90 minutes at a time and, of course, as hard as I could go. One night I was practicing serves for an upcoming tournament when suddenly my elbow felt funny and I couldn’t lift my racquet. My elbow was killing me. I went to the club café and got a bag of ice. I iced it the next day and it seemed better. Over the next 10 days the pain was so bad I couldn’t sleep and it hurt to do anything that involved gripping. I made an appointment with a sports medicine orthopedic surgeon who specializes in sports injuries and was told I had tennis elbow, or technically “lateral epicondylitis.” Doc gave me a shot of cortisone and sent me to physical therapy 3 times a week, and to come back in 3 weeks.

Physical Therapy for Common Extensor Tendon Tear

I did the physical therapy for two weeks without any change, good or bad. I quit the PT and went back to Doc after 3 weeks with my elbow still in pain. He gave me another cortisone shot and said if it wasn’t better in 2 weeks he would order an MRI. If the elbow was sore just due to inflammation, then the cortisone should have cured it. But if there was a mechanical problem—such as a tear—then the cortisone would not work and I would need surgery. After 2 weeks the cortisone had worn off and the elbow was no better; I had an MRI.

The MRI showed a large, high-grade tear in the common extensor tendon—high grade tear means more than 70% of the tendon is torn. He told me to schedule surgery with his front office and in the meantime not to do lift anything heavy or do anything that made the elbow hurt. I was already doing that! Surgery would release the tendon (cut it the rest of the way—that is, a complete tear). If needed, he would cut out damaged tissue, pare down the bone if there were any bone spurs and then sew the tendon back to where it tore away from the bone. I would be in a fixed brace for a week, start physical therapy in week 2 and would be good as new in 3-4 weeks. I thought, no way.

After talking with a few people I find out how painful it is to come back from the surgery and if you don’t work your butt off in PT you will likely lose 10% range-of-motion in the elbow. I would still be able to comb my hair and wipe my butt, but my squash and golf games would likely suffer. If I didn’t have the surgery I could have permanent injury to my elbow, not to mention pain. I was torn. I didn’t want the surgery but wanted to play. Surgery is always dangerous, even the routine simple ones. You never know. My sister had surgery a few weeks ago and the man in the bed next to her in the recovery room died at 42 in recovery from a routine gallbladder removal. Bled to death because the surgeon nicked an artery punching his way through the guy’s belly with a laparoscope. Done all the time. Death extremely rare, but—it happens.

My sister had surgery on her back. She has stage IV breast cancer. The cancer came back 4 years ago in her spine and pelvic bone. So when she started having pain down her leg a few months ago, she had a CAT scan. The radiologist saw “something” and told her to go see her radiation oncologist for radiation. It was probably a tumor. The radiation oncologist didn’t think it was a tumor, “could be bone,” and sent her to the top neurologist in our city. THE man. He told her she needed to have what-ever-it-is removed and 6 vertebrae in her spine fused. Rods, pins, screws, pain, PT, out of work for months and possible permanent disability. She was devastated. The “tumor” was where they couldn’t biopsy it so they weren’t sure what it was. So she decided to wait and see if it grew. If it grows, it’s a cancer tumor, if it doesn’t grow it’s not. After 2 months the pain was so bad she had to do something but she just couldn’t accept she had to have half of her back fused. So she asked her oncologist for a referral for a second opinion. The second neurologist said she didn’t have a tumor and he can go in with a 1 inch incision and cut the cyst off the nerve, she would be pain-free in the recovery room and back to work in 2 weeks. She had the surgery and just as he said, it was a synovial cyst and she was back to work in 2 weeks. So I followed her lead.

I made an appointment with an orthopedist I have known long time to get a second opinion about elbow surgery. If I can heal without it, I don’t want surgery. He thinks I can heal by doing physical therapy so he sent me to physical therapy for 3 weeks and then we will see. It’s been a week with PT. It has been painful but I have done my exercises faithfully. The physical therapist also thinks I can heal it without surgery. I’m gonna give it my best effort. Here’s hoping!

Follow up Status on Healing of Common Extensor Tendon Tear

Well, I managed to do enough physical therapy to prevent surgery. However, the tear in the extensor tendon lead to problems in my shoulders and arms and a drug reaction to cortisone. Here it is 4 months later, and I’m in worse shape than I started.