When you’re dealing with the persistent pain of tennis elbow, your first instinct is likely to try the most common remedies. Doctors often recommend a conservative approach to start, which can be effective for minor cases. However, for many people with chronic or severe tendon pain, these standard treatments don’t provide lasting relief. They tend to manage the symptoms rather than addressing the root cause of the tissue damage—the microscopic tears in the tendon responsible for your discomfort.
When conservative treatments fail, surgery is often presented as the final option. A surgeon may recommend a procedure to remove the damaged tendon tissue.
Headline: One type of tennis elbow surgery, with a track record of “excellent” results, is found to be no more effective than placebo or sham surgery.
When conservative treatments do not respond, often a patient is suggested to surgery. In 2018, Australian surgeons made headlines when they published their study in the American Journal of Sports Medicine (1) comparing tennis elbow surgery to placebo surgery.
Here is what the research team wrote:
“A number of surgical techniques for managing tennis elbow have been described. One of the most frequently performed involves excising (shaving away) the affected portion of the extensor carpi radialis brevis (ECRB, a muscle of the forearm). The results of this technique, as well as most other described surgical techniques for this condition, have been reported as excellent, yet none have been compared with placebo surgery.”
When the surgery was compared to a sham surgery, the doctors concluded: “this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow.” So the surgical removal of damaged tissue did not help the patient anymore than the conservative treatments. How about regenerative treatments?
A reassessment of tennis elbow surgery
In an April 2022 study, researchers found that in previously medical studies (2), patients who received a placebo or no-treatment about 90% of them achieved symptom resolution at one year. In this study the researchers noted: “Surgeons often recommend surgery if symptoms persist despite nonsurgical management, but operations for tennis elbow are inconsistent in their efficacy, and what we know about those operations often derives from observational studies that assume the condition does not continue to improve over time. This assumption is largely untested, and it may not be true. ” Their findings followed that people who had no treatment seemed to do very well after one year and that surgical recommendation maybe premature: “The probability of resolution appears to remain constant throughout the first year of follow-up and does not depend on previous symptom duration, undermining the rationale that surgery is appropriate if symptoms persist beyond a certain point of time. We recommend that clinicians inform people who are frustrated with persisting symptoms that this is not a cause for apprehension, given that spontaneous improvement is about as likely during the subsequent few months as it was early after the symptoms first appeared. Because of the high likelihood of spontaneous recovery, any active intervention needs to be justified by high levels of early efficacy and little or no risk to outperform watchful waiting.”
Approximately 85%-90% of patients respond satisfactorily to conservative treatment, but in resistant patients, surgical treatment is considered
A May 2022 paper (3) wrote: “Approximately 85%-90% of patients respond satisfactorily to conservative treatment, but in resistant patients, surgical treatment is considered. Classic open surgery is successful in between 70% and 97% of patients, similarly to more modern techniques such as arthroscopy. (In this) retrospective study of 47 working-age patients with resistant lateral epicondylitis: 27 underwent arthroscopic surgery and 20 underwent open surgery. ” Between the two procedures, no statistically significant differences were observed between the groups in the reduction in reduced pain or disability socres. The differences in terms of time off were also not statistically significant. The period of work leave corresponded, on average, to 84 days in the arthroscopy group and 90 days in the open surgery group. Conclusions: “Arthroscopic surgery and open surgery provide similar functional results and pain reduction in the treatment of lateral epicondylitis.”
Cortisone before surgery. Does it effect outcomes?
A June 2023 study (4) of 99 patients who received corticosteroid injections before surgery, suggests; “The number of preoperative corticosteroid injections does not appear to affect postoperative clinical outcomes of patients with lateral epicondylitis who undergo surgery.”
References
1 Kroslak M, Murrell GAC. Surgical Treatment of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Am J Sports Med. 2018 Mar 1:363546517753385. doi: 10.1177/0363546517753385.
2 Ikonen J, Lähdeoja T, Ardern CL, Buchbinder R, Reito A, Karjalainen T. Persistent tennis elbow symptoms have little prognostic value: a systematic review and meta-analysis. Clinical Orthopaedics and Related Research®. 2021 Dec 8:10-97.
3 López-Alameda S, Varillas-Delgado D, De Felipe-Gallego J, González-Granados MG, Hernández-Castillejo LE, García-de Lucas F. Arthroscopic surgery versus open surgery for lateral epicondylitis in an active work population: a comparative study. Journal of Shoulder and Elbow Surgery. 2022 May 1;31(5):984-90.
4 Ha C, Cho W, Hong IT, Park J, Ahn W, Han SH. Effect of Repetitive Corticosteroid Injection on Tennis Elbow Surgery. The American Journal of Sports Medicine. 2023 Jun;51(7):1886-94.
