Elbow Tenotomy

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What is elbow tenotomy?

elbow pain

Elbow tenotomy is surgery to treat tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis). Both conditions result from overuse of the elbow and cause elbow pain and tenderness. With repeated stress, the elbow tendons can develop micro-tears and eventually form scar tissue in an attempt to protect the tendon. Elbow tenotomy involves trimming damaged or scarred tendon tissue. It can restore pain-free range of motion and elbow function.

Elbow tenotomy is major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment options before having an elbow tenotomy.

Types of elbow tenotomy 

The types of elbow tenotomy include: 

  • Percutaneous tenotomy uses ultrasound guidance to insert a needle into the scarred tendon. The needle breaks up scar tissue with ultrasound waves and suctions out the treated tissue. This technique does not require incisions and uses a numbing agent instead of anesthesia.

  • Surgical tenotomy uses either traditional open surgery methods or arthroscopic methods to remove scarred or damaged tendon tissue.

Other procedures that may be performed

Your doctor may perform other procedures in addition to elbow tenotomy. These include:

  • Muscle or bone debridement involves removing diseased tissue.

  • Tendon release involves cutting the tendon from the bone.

  • Tendon repair involves reattaching the ends of large tendon tears and tightening the tendon.

Why is elbow tenotomy performed?

Your doctor may recommend elbow tenotomy to treat elbow pain that has not improved with less invasive treatments, such as rest and medication. Your doctor may only consider elbow tenotomy if other treatments do not improve your pain and elbow function for six months or longer. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend elbow tenotomy to treat elbow pain due to: 

  • Golfer’s elbow, baseball elbow, or suitcase elbow (medial epicondylitis), which is an inflammation of the tendons that attach the forearm muscles to the inside of the elbow joint 

  • Tennis elbow (lateral epicondylitis), which is an inflammation of the tendons that attach the forearm muscles to the outside of the elbow joint

Who performs elbow tenotomy?

Orthopedic surgeons and  hand surgeons perform elbow tenotomy.  Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments.  Hand surgeons are orthopedic or plastic surgeons who further specialize in surgery of the hand, wrist, forearm and elbow.

How is elbow tenotomy performed?

Your elbow tenotomy will be performed in a hospital or outpatient surgery setting. Your surgeon can use either the percutaneous needle tenotomy technique or surgical techniques requiring incisions and anesthesia to perform you elbow tenotomy.

Surgical approaches to elbow tenotomy

Your surgeon will perform your surgical elbow tenotomy using one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and an arthroscope through at least two small incisions in your elbow. The arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your joint to a video screen. Your surgeon sees the inside of your joint on the screen as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues. Your doctor will make a small incision instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery involves making a large incision in the back of your elbow. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your surgeon will advise you on which procedure is best for you and if you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different elbow tenotomy surgeries and ask why your surgeon will use a particular type of procedure for you.
Types of anesthesia 

Your surgeon will perform your surgical elbow tenotomy using either general anesthesia or regional anesthesia. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your elbow tenotomy

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.

  • The surgical team will monitor your vital signs and critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of elbow tenotomy?

As with all surgeries, elbow tenotomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot

  • Infection 

Potential complications of elbow tenotomy

Problems with elbow tenotomy are not common but include:

  • Loss of strength and flexibility

  • Need for additional surgery

  • Nerve or blood vessel damage

  • Ongoing elbow pain

  • Prolonged rehabilitation

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.

  • Informing your doctor if you are nursing or there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my elbow tenotomy?

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for elbow tenotomy by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Arranging for a ride home after surgery. It is also a good idea to have someone stay with you for the first 24 hours.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need elbow tenotomy? Are there any other options for treating my condition?

  • If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • When will I start physical therapy? Where do I go for it?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my elbow tenotomy?

Knowing what to expect can help make your road to recovery after elbow tenotomy as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. 

You may go home the same day of your surgery or stay overnight in the hospital, depending on your condition. You will need to wear a splint for up to one week after surgery. The splint will immobilize and protect your elbow. When you are done with the splint, you will have physical therapy to help you recover and regain elbow strength and movement. Your surgeon or therapist will tell you when it is safe to return to your normal activities.

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. Full recovery takes up to six months. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up and physical therapy appointments after elbow tenotomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Numbness or tingling in the affected arm or hand

  • Pain that is not controlled by your pain medication

  • Unexpected drainage, pus, redness or swelling of your incision

How might elbow tenotomy affect my everyday life?

Elbow tenotomy is successful for most people. It can reduce your symptoms and improve elbow function so you can lead an active, normal life. However, it is common to lose some degree of strength in the elbow.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 11
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  3. Mayo Clinic Develops Incision-Free Surgery for Tennis Elbow. Mayo Clinic. http://www.mayoclinic.org/news2013-mchi/7376.html
  4. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
  5. Surgery for Elbow Pain (Tennis Elbow). Cochrane Reviews. http://summaries.cochrane.org/CD003525/surgery-for-elbow-pain-tennis-elbow
  6. Tennis Elbow (Lateral Epicondylitis). American Academy of Orthopedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00068
  7. Skinner HB, McMahon PJ. Current Diagnosis & Treatment on Orthopedics, 5th ed. New York: McGraw-Hill, 2014
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