Surgery for Tennis Elbow?

[clp34vmp]

Almost a year ago, I did a post on here asking for help with a case of tennis elbow that I developed out of nowhere last January. I received a ton of great feedback, so thanks to everyone who weighed in. Unfortunately, nothing has worked for me. I've spent countless hours researching this thing, and I've tried literally just about everything out there - ice, heat, physical therapy, the Flexbar, Cryotherapy, and now finally acupuncture. It's a year later, though, and unfortunately I'm in the exact same place. I was able to play a decent amount of golf this past year, but I really limited the time I would normally spend at the driving range. I would basically play on the weekends and, during the week, if I practiced, it would just be chipping and putting. Tennis, which I also normally play a bit of, was a complete no go.

 

I'm sure I would have been better off shutting things down right away and not resuming normal activity until I had it resolved, but unfortunately I didn't. I did finally shut things down for good after Thanksgiving and have really rested it since but have not seen any difference. When I had my second cortisone shot back in October, the Orthopedic surgeon (who is an upper-extremity specialist) said it was worth trying the shot one more time, but that if it didn't work he felt surgery would be the next option.

 

It has always been my goal since the tennis elbow first came on to find a solution on my own without surgery, but I think I might be ready to throw in the towel. I thought I would ask if anyone else out there has had this surgery, and if so, did it work fully to solve the issue? How was the recovery? Were you able to regain the same level of strength and flexibility you had before? I kind of dread taking this next step (especially because it's obviously going to wash out a big chunk of the upcoming golf season for me), but I think it probably makes sense to get it taken care of and get it behind me. Would love to hear any feedback from anyone out there with first hand experience.

[rajman]

Maybe look into stem cell therapy.  I have heard good things about it, but have no personal experience with it.  Below is an example of a website discussing it:

 

https://www.bostonstemcell.com/conditions-treated/stem-cell-treatment-for-elbow-pain/

[josephnaas]

ESWT

[mukster]

https://www.sciencedaily.com/releases/2019/10/191001132643.htm

[YMark]

26 minutes ago, josephnaas said:

ESWT

 

Is this a game called guess the acronym? Or are you short on time to type it out?

[josephnaas]

10 hours ago, YMark said:

 

Is this a game called guess the acronym? Or are you short on time to type it out?

If one types ESWT into google search engine....the answer is at the top of the results list.  Extracorporeal shock wave therapy. 

[Hawkeye77]

1 hour ago, josephnaas said:

If one types ESWT into google search engine....the answer is at the top of the results list.  Extracorporeal shock wave therapy. 

GTFO! 😉

[xkilgorextroutx]

I didn't need surgery since treatment & exercises worked for me. They didn't work for my sister-in-law (to be fair, I don't think she put a lot of effort into them) so she had surgery. In a sling for one month and very limited motion for a little while. She's reported no pain at this point and full range of motion.

[Hawkeye77]

I had surgery for tennis elbow almost a year ago.  Elbow is better vs. what it was (I can grip my phone at work for a couple minutes without having to lean my whole body over to hang it up - no lie).  But now have nagging pain in a slightly different spot and apparently Dr. Dips__t nicked a nerve because I have had numbness in some fingers on my left hand since the anesthetic wore off (we won't go into that today).  I can grab a club and grip it without pain, which I couldn't do at this time last year.  Took awhile to adjust to hitting the ground again - I'd had the pain for most of two seasons prior.  Three cortisone shots were the limit for me.  So, that's the summary.  Not what was expected and not what was pretty specifically assured, oh well.  Things stay as they are I'll be consulting with someone else this summer just to see what the prognosis is, and not golfing for a couple months seems to have helped, but really no way to know until I start playing again.  Recovery was basically simple rehab stretches, started little wedge swings after about 6-8 weeks but took it really, really slow, can't stress that enough.

 

Now, all that has absolutely nothing to do with your specific condition, what's going on inside your specific elbow, how you will respond to whatever procedure is done, etc. 

 

I shared because you asked and I had surgery, but why would anything anyone says about their specific medical condition relate to a decision you need to make with your doctor and if not sure, then you should consult . . . . another doctor with a full examination.  Asking for experiences makes some sense, but asking for opinions on whether you should have surgery makes no sense at all.  

 

Good luck!

Edited January 26, 2021 by Hawkeye77

[thechief16]

Yes, I had the surgery about 10 years ago and would categorize it as 100% successful, to the point where I don't even think about it anymore (seeing this post was the first time I've thought about it in a couple years, other than remembering to note it on medical forms that ask whether you have had surgery). I was faithful on my rehab/PT and don't recall losing a ton of time off the course.  How long are they telling you before you can hit balls post-surgery?

[clp34vmp]

One thing I've been surprised about in dealing with this tennis elbow problem for the past year is how many people I've met who have had it. I had no idea it was such a common condition. And pretty much everyone you discuss it with has some strong opinions on what will work and won't work to fix the problem. Every time someone has told me about something they've had success with I've run off and tried it. I just haven't found anything that works for me yet.

I've heard from several people that acupuncture is what did it for them, but I've had three sessions so far with no luck. I'll probably at least try one or two more. Anyway, I realize that no one is going to be able to tell me what exactly will work for me and, more specifically, I realize that there's no way anyone is going to be able to tell me whether surgery is the right solution for my specific case. I am definitely reluctant to move forward with it, though, so I guess I was hoping to hear a lot of positive comments from those on here who have had it so perhaps I'd feel more confident in my decision on the next step. I guess there are still a few things out there I haven't tried - Shockwave therapy, Nitroglycerine patches, and Platelet-rich Plasma are three options I suppose I could still try. I'm just sick of chasing solutions only not to get anywhere, and I'm wondering if I might just be better off biting the bullet and getting it over with. They're telling it would be 4-5 months from the surgery until I would be back to normal activity, which I guess isn't a huge deal in the grand scheme of things. 

[thechief16]

I think I was 3 months.  Timed it to have it done in December, so it didn't feel like I was missing much golf.

[johnrobison]

On 1/26/2021 at 1:15 PM, clp34vmp said:

They're telling it would be 4-5 months from the surgery until I would be back to normal activity, which I guess isn't a huge deal in the grand scheme of things. 

What did you end up doing, if anything? There is a surgical procedure which doesn't require a lengthy recovery - denervation - and I'm discussing it with my Dr (Rose, in the abstract I linked) tomorrow.

 

I haven't been able to swing with both arms since injuring my left (lead) arm in August and developing a pretty nasty case of tennis elbow. I've done PT and cortisone with minor improvement so the next step is either PRP (which is a 3 month process) or denervation surgery. The surgery is quite simple and recovery is virtually immediate.

 

I came here hoping someone might have had this specific procedure, as opposed to lateral epicondylectomy, with some insight to share.

[clp34vmp]

On 3/7/2021 at 9:01 AM, johnrobison said:

What did you end up doing, if anything? There is a surgical procedure which doesn't require a lengthy recovery - denervation - and I'm discussing it with my Dr (Rose, in the abstract I linked) tomorrow.

 

I haven't been able to swing with both arms since injuring my left (lead) arm in August and developing a pretty nasty case of tennis elbow. I've done PT and cortisone with minor improvement so the next step is either PRP (which is a 3 month process) or denervation surgery. The surgery is quite simple and recovery is virtually immediate.

 

I came here hoping someone might have had this specific procedure, as opposed to lateral epicondylectomy, with some insight to share.

I decided to give PRP a try. I had it done almost exactly a month ago. I then started back up with physical therapy two weeks ago. I was told if it's going to work I'd likely see the results some time between 1-3 months after having it done. So far it hasn't resolved the problem. I had the PRP done through the Sports Medicine clinic at the University medical center where I live. The ultrasound that they used during the PRP procedure showed I had a small bit of tearing in the tendon and a bone spur which the doctor felt probably wasn't the cause of the pain. I go back to see him again in a couple of weeks, so I imagine they'll look at it with the ultrasound again to see if there've been any changes.

 

I'm trying to stay patient. I haven't hit a golf ball in over three months now. The weather is getting nice and would love to get back out there, but I'm going to give it a bit more time. Definitely feeling frustrated; it's been over a year now and nothing has worked. With the PRP not being covered by insurance (at least for me), I'm not sure I'd take a second stab at it. if this doesn't work, I guess it will be surgery or just deal with it. I've been dealing with it so long it's starting to feel permanent.

[Barfolomew]

Oh injuries we go waaay back.... best of luck!

[TheGolfingRealtor]

I just had the surgery done 8 weeks ago and I will get the other arm done after this season. 
 

Find a surgeon that won’t put a cast on afterwards. Worst experience of my life! I suffered a little muscle atrophy and spent the last two weeks trying to regain full use of my arm again. I did not need OT or PT afterwards which was nice. 
 

Like I mentioned, I’m only 8 weeks post op but I’ve hit balls a couple of times with no issues in the repaired elbow other than mild tenderness. The other elbow aches pretty good though. I can’t hit balls on back to back day either. 
 

I’m in the process of switching to the new Project X IO shaft to see if that helps. 

[johnrobison]

10 hours ago, clp34vmp said:

I decided to give PRP a try. I had it done almost exactly a month ago. I then started back up with physical therapy two weeks ago. I was told if it's going to work I'd likely see the results some time between 1-3 months after having it done. So far it hasn't resolved the problem. I had the PRP done through the Sports Medicine clinic at the University medical center where I live. The ultrasound that they used during the PRP procedure showed I had a small bit of tearing in the tendon and a bone spur which the doctor felt probably wasn't the cause of the pain. I go back to see him again in a couple of weeks, so I imagine they'll look at it with the ultrasound again to see if there've been any changes.

 

I'm trying to stay patient. I haven't hit a golf ball in over three months now. The weather is getting nice and would love to get back out there, but I'm going to give it a bit more time. Definitely feeling frustrated; it's been over a year now and nothing has worked. With the PRP not being covered by insurance (at least for me), I'm not sure I'd take a second stab at it. if this doesn't work, I guess it will be surgery or just deal with it. I've been dealing with it so long it's starting to feel permanent.

Sorry to hear that. My injury was in August and, yes, it's incredibly frustrating. I've had achilles surgery, knee surgery, and then passed on surgery for a torn shoulder labrum and torn knee cartilage, and this pesky m-epher is the worst of them all!

 

I see the doc today and will discuss whether to do the denervation surgery that I linked to earlier. I'm leaning toward doing it and will report back here for an update.

 

FWIW... You said you haven't hit a ball in 3 months. I've been practicing the whole time, just using my good arm (trail arm, in my case) and recommend it to anyone. It was frustrating at first because I couldn't compensate for some of my swing faults. Extremely frustrating! However, over time, it really forced me to address those faults and improve some of my mechanics. I've always known the value of one-arm swings but would never do them because I sucked at them. Being force to do them (because I'm not just gonna stop practicing) is the only good thing that came from this.

 

Edit: Partial lateral epicondyle denervation surgery scheduled for 3/24. Will update on results for anyone interested.

Edited March 9, 2021 by johnrobison

[i*windows]

My dr recommended stem cell treatment before surgery 

[clp34vmp]

1 hour ago, i*windows said:

My dr recommended stem cell treatment before surgery 

 

I think that's pretty expensive, and for me anyway that would not be covered I don't think. The PRP for me was about $800, not cheap but not too horrible. (The fact that it is not working, at least so far, is certainly making it feel more expensive, however.)

 

The denervation definitely sounds interesting to me. My guy would just be doing the standard procedure for lateral epicondylitis; he is the head of all orthopedics here at the university medical center and I think is very well respected, but I get the sense that he's not a fan of new or alternative types of treatment.

[johnrobison]

Less invasive treatments are always advised prior to surgery. Denervation is different from other procedures, though, in that the only thing being done is a nerve being detached. No bone grinding. No tendon removal. So no structural changes that could lead to long-term problems, like with discectomies and such. And the only healing/recovery is the closing up of the incision. As Dr Rose put it, the only drawback to this surgery (aside from the standard caveats of getting an infection, etc...) is that it might not be 100% effective and you'll end up with a scar on your elbow.

 

There was a quick test that we did yesterday before deciding on surgery. He injected lidocaine in my elbow to deaden the nerve that would be detached. 15 minutes later I performed the grip test and did so with virtually no pain (the first time I tested I nearly dropped the device, not expecting so much pain from it) which proved to him and that I'm a good candidate for the surgery. The likelihood of the surgery being effective after passing his lidocaine test is 90%, according to him.

 

If my options were PRP, SCT, and epicondylectomy, I would start PRP treatments first. I'm currently living with torn cartilage in a knee and a shoulder, as well as a ruptured disc in my back because I don't like having those bits cut away. But this denervation procedure is completely different and the best option for me right now.

[clp34vmp]

On 3/9/2021 at 1:51 PM, johnrobison said:

Less invasive treatments are always advised prior to surgery. Denervation is different from other procedures, though, in that the only thing being done is a nerve being detached. No bone grinding. No tendon removal. So no structural changes that could lead to long-term problems, like with discectomies and such. And the only healing/recovery is the closing up of the incision. As Dr Rose put it, the only drawback to this surgery (aside from the standard caveats of getting an infection, etc...) is that it might not be 100% effective and you'll end up with a scar on your elbow.

 

There was a quick test that we did yesterday before deciding on surgery. He injected lidocaine in my elbow to deaden the nerve that would be detached. 15 minutes later I performed the grip test and did so with virtually no pain (the first time I tested I nearly dropped the device, not expecting so much pain from it) which proved to him and that I'm a good candidate for the surgery. The likelihood of the surgery being effective after passing his lidocaine test is 90%, according to him.

 

If my options were PRP, SCT, and epicondylectomy, I would start PRP treatments first. I'm currently living with torn cartilage in a knee and a shoulder, as well as a ruptured disc in my back because I don't like having those bits cut away. But this denervation procedure is completely different and the best option for me right now.

 

I'm definitely interested to hear how it turns out for you - good luck!

[J13]

I had tennis elbow surgery last year after trying to fix it on my own for months and months.  I did all sorts of treatments, rehabs, exercise, ect...  and wasted a LOT of money along the way.  Honestly, if I could go back in time I would have skipped all the nonsense and just got it repaired.  Doctor did a great job and I was back to hitting balls and playing in 8-10 weeks post OP.  

 

If you haven't already get an MRI.  If you have a high grade tendon tear then get the surgery and end the misery.  My elbow is 100% now and even though i'm a year removed from surgery I still do theraband stuff and other movements from my physical therapy.  I would argue my elbow is probably stronger now then it was pre injury.

[clp34vmp]

On 3/10/2021 at 3:30 PM, J13 said:

I had tennis elbow surgery last year after trying to fix it on my own for months and months.  I did all sorts of treatments, rehabs, exercise, ect...  and wasted a LOT of money along the way.  Honestly, if I could go back in time I would have skipped all the nonsense and just got it repaired.  Doctor did a great job and I was back to hitting balls and playing in 8-10 weeks post OP.  

 

If you haven't already get an MRI.  If you have a high grade tendon tear then get the surgery and end the misery.  My elbow is 100% now and even though i'm a year removed from surgery I still do theraband stuff and other movements from my physical therapy.  I would argue my elbow is probably stronger now then it was pre injury.

 

Quick update on this one - I am becoming more and more convinced lately that the pain in my elbow is actual not tennis elbow (at least not anymore) but instead the result of a bone spur. I was totally unfamiliar with bone spurs, although you definitely hear about baseball pitchers getting them in their elbows. The first time I heard about it in my specific case was when I went for my PRP - the doctor observed it when using the ultrasound during the procedure. At the time, he didn't think that was the likely cause of my issues. Now, six weeks after the PRP and a month into resuming Physical Therapy, I'm starting to feel pretty sure that it is. Through the PT, mainly using the Flex Bar with some other stuff mixed in, I have most definitely improved my grip strength and the flexibility in my wrist. The pain remains, though, but only in a very specific spot right at the top outside of the bone at the elbow joint. That location clearly sticks out much more prominently on my dominant arm as opposed to the same spot on my left. My wife told me she can see it sticking out from like 10 ft. away.

 

Anyway, I just went back to the doctor for my six week check on the PRP. The ultrasound showed definite healing in the tendon and confirmed that the bone spur is in the specific location where I'm feeling the pain. He looked at the elbow in my other arm and that same location is entirely smooth and much less prominent. He still thinks, though, that I should give the PRP a little more time to work before considering next steps. He thought I should wait another month, and then we can reevaluate. An MRI would probably be the next logical step, but I'm not sure exactly how much that could confirm what the actual source of the pain is. Much like J13, if I could do it all over again, I'd just go back and get the problem (whatever it is) taken care of surgically and move on with my life. I feel like I've wasted a year screwing around with all this stuff only to be in the exact same place. I hit hit a few balls on Sunday for the first time in three and a half months, and it hurt like hell. Ugh.

 

[J13]

5 hours ago, clp34vmp said:

 

Quick update on this one - I am becoming more and more convinced lately that the pain in my elbow is actual not tennis elbow (at least not anymore) but instead the result of a bone spur. I was totally unfamiliar with bone spurs, although you definitely hear about baseball pitchers getting them in their elbows. The first time I heard about it in my specific case was when I went for my PRP - the doctor observed it when using the ultrasound during the procedure. At the time, he didn't think that was the likely cause of my issues. Now, six weeks after the PRP and a month into resuming Physical Therapy, I'm starting to feel pretty sure that it is. Through the PT, mainly using the Flex Bar with some other stuff mixed in, I have most definitely improved my grip strength and the flexibility in my wrist. The pain remains, though, but only in a very specific spot right at the top outside of the bone at the elbow joint. That location clearly sticks out much more prominently on my dominant arm as opposed to the same spot on my left. My wife told me she can see it sticking out from like 10 ft. away.

 

Anyway, I just went back to the doctor for my six week check on the PRP. The ultrasound showed definite healing in the tendon and confirmed that the bone spur is in the specific location where I'm feeling the pain. He looked at the elbow in my other arm and that same location is entirely smooth and much less prominent. He still thinks, though, that I should give the PRP a little more time to work before considering next steps. He thought I should wait another month, and then we can reevaluate. An MRI would probably be the next logical step, but I'm not sure exactly how much that could confirm what the actual source of the pain is. Much like J13, if I could do it all over again, I'd just go back and get the problem (whatever it is) taken care of surgically and move on with my life. I feel like I've wasted a year screwing around with all this stuff only to be in the exact same place. I hit hit a few balls on Sunday for the first time in three and a half months, and it hurt like hell. Ugh.

 

I’m glad you are pinpointing the issue. Not sure the heal time for bone Spurs but hopefully it’s better than tennis elbow surgery.  But as I said above I went deep down the rabbit hole and wish I hadn’t wasted the time.  
 

if I could start over I would have done the following:

 

1. Educated myself on corrective exercises and get a cortisone shot. And most importantly rested the elbow for a month. 
 

That probably would have nipped it in the bud but I kept trucking along like a dummy and really did some damage 

[Barfolomew]

Maybe cause you have golfers elbow and not tennis elbow.... jus sayin

[clp34vmp]

36 minutes ago, Barfolomew said:

Maybe cause you have golfers elbow and not tennis elbow.... jus sayin

Huh?? Golfers elbow is on the inside of the elbow, not the outside. 

[johnrobison]

Not much to report yet but I just got back from the denervation surgery and it was pretty simple. So simple that I asked them for a sedative and no general anesthesia, which was great! The procedure took all of 16 minutes from incision to sutures and I just have to keep my arm in a sling for a good portion of the day over the next week. After that it's just a matter of waiting for the incision to heal. There's no healing to wait for or rehab other than allowing the detached nerve to settle into its new location, retracted up under my triceps muscle. Other than the incision, no pain.

 

Follow up with the surgeon is in a week and then it should be another 3 weeks after that when I'm allowed to hit balls again. I'll report back on whether and how much the denervation reduced the pain.

[Barfolomew]

Sounds great! Best of luck!

[clp34vmp]

21 hours ago, johnrobison said:

Not much to report yet but I just got back from the denervation surgery and it was pretty simple. So simple that I asked them for a sedative and no general anesthesia, which was great! The procedure took all of 16 minutes from incision to sutures and I just have to keep my arm in a sling for a good portion of the day over the next week. After that it's just a matter of waiting for the incision to heal. There's no healing to wait for or rehab other than allowing the detached nerve to settle into its new location, retracted up under my triceps muscle. Other than the incision, no pain.

 

Follow up with the surgeon is in a week and then it should be another 3 weeks after that when I'm allowed to hit balls again. I'll report back on whether and how much the denervation reduced the pain.

3 weeks to hitting balls again pain free would be really amazing. Looking forward to hearing how it's going then.

[johnrobison]

3 weeks from the follow up, so 4 weeks from today. Still... amazing indeed!