lateral epicondylitis (Tennis elbow)
This condition is the bugbear of many a physician and surgeon.
The principal reason is that there are no good treatments for it. There is not one individual treatment which has universal acceptance and it is really a matter of finding what works for the individual patient.
The natural history of this condition is for significant improvement in symptoms over a period of 12 to 18 months (i.e. it will get better by itself). It is likely that symptoms will persist for the remainder of a patient’s life, although most will be able to tolerate mild symptoms.
Non operative treatment incorporates initially avoiding the provocative action (i.e. not doing repetitive wrist extension movements), anti-inflammatory medications, hand therapy (splinting and exercises), occasional injections (either steroid or platelet rich plasma), and simply time.
Very rarely do we operate on patients with this condition. There is no agreed standard surgical procedure. Indeed, there are probably 30 different iterations of the surgery, none of which has universal acceptance.
For me, surgery is indicated in a patient who has exhausted non operative treatment (see above), they have definable pathology (i.e. a partial thickness tear on MRI) and the pain is isolated to the lateral epicondyle.
Surgery can generally be broken down into repair or release procedures. Release procedures involve cutting the origin of the tendon from the bone at the outer elbow so that it does not pull against the bone any more. Repair procedures involve repairing the tendon onto the bone using a device called an anchor (essentially a piece of plastic that sits in the bone and has ropes coming out of it that are used to secure the tendon onto the bone).
No surgery is universally good (unfortunately). If you read the studies about the various techniques they report high rates of success, however, in my experience and certainly what I have learned from my mentors is that this is not usually the case.