0330 088 7800
Lateral epicondylitis or tennis elbow is inflammation of the outer part of the elbow joint that is caused by overuse of the muscles and tendons of the forearm and elbow. Repeating any type of activities over and over again can put a strain on the elbow tendons around the lateral epicondyle (the bone that protrudes on the outer side of the elbow). This strain can cause damage and inflammation of the tissues and cells around these tendons. Activities that bring about lateral epicondylitis aren’t limited to backhand swings in tennis and can be brought about by many other similar actions. The main symptom of tennis elbow includes tenderness and pain at the lateral epicondyle of the elbow and may spread down the forearm. Bending at the wrist, twisting the forearm or grasping objects may aggravate the symptoms. Lateral epicondylitis may also result in significant weakness and stiffness in the muscles around the elbow, forearm and wrist.
Tennis elbow can be successfully treated conservatively (non-surgically) with a comprehensive physiotherapy programme. However, in severe cases of lateral epicondylitis surgery may be required. Surgery is needed when the condition is causing significant amount of pain and discomfort and conservative treatment alone has failed to alleviate the symptoms. Lateral epicondylitis release surgery takes the tension off the tendons in the elbow and it is crucial to treat symptoms such as severe pain, stiffness and loss of function that is associated with tennis elbow (lateral epicondylitis).
Lateral epicondylitis surgery involves the surgeon making a small incision along the arm over the lateral epicondyle. Soft tissues are gently moved to the side so that the surgeon has clear access to the joint. The extensor tendon is then cut where it attaches to the lateral epicondyle. The surgeon splits the tendon and then removes any adhesions or scar tissue that may be causing any problems. At this time, the surgeon may also remove any bone spurs that are potentially aggravating the elbow joint (bone growths that accumulate on the joint surfaces). In some cases, the tendon is then attached to nearby soft tissues (fascia). After releasing strained soft tissues and removing structures that are causing tennis elbow symptoms, the wound is then closed using stitches or sutures.
Physiotherapy after lateral epicondylitis release is imperative to maximise the success of the surgery, prevent the likelihood of any problems occurring and to help guarantee the return of full or near to full strength and function in the elbow.
Above: Soft tissue massage of the the connective tissues around the elbowPhysiotherapy before lateral epicondylitis release
Physiotherapy is recommended before you undergo lateral epicondylitis release surgery and the main aim of physiotherapy at this time is to better prepare your elbow for the surgery and promote a more rapid and problem free recovery after your elbow surgery. Physio.co.uk offers a physiotherapy programme for before the medial epicondylitis release surgery that aims to strengthen the muscles around your elbow, wrist and shoulder whilst also including activities that improve your cardiovascular fitness and muscle endurance for maximum preparation before your operation.
Symptoms after lateral epicondylitis release
Once you have undergone lateral epicondylitis release surgery you will experience pain, swelling and stiffness within your elbow joint. You will also experience a short term reduction in range of movement and function in your elbow joint and upper limb. Immediately after surgery, the wound will be covered with thick dressing and your elbow will be placed in a removable splint that keeps your elbow bent at a 90 degree angle. You will be provided with a sling for the first stages after the surgery and you will be given pain killers to control the pain. You will also be advised to keep your elbow elevated to reduce swelling as much as possible. Physiotherapy should begin in the initial period after lateral epicondylitis and should carry on until you have regained full or near to full function in your elbow joint. Repetitive bending of the elbow or lifting anything heavy is ill advised in the first stages after your operation. You will have to avoid activities that aggravated lateral epicondylitis. Furthermore, you will be unable to drive until you have full and painless range of movement in your elbow.
Above: Passive stretches and mobilisations of the elbow by MSK therapistPhysiotherapy after lateral epicondylitis release
After undergoing medial epicondylitis surgery it is essential to take part in a comprehensive physiotherapy course to maximise the success of the surgery, to prevent the likelihood of further problems or symptoms and to give you back full or near to full function in your elbow as soon as possible. Physio.co.uk offers a personal physiotherapy programme that focuses on returning the full range of movement and strengthening the muscles to achieve maximum function and recovery in your elbow joint.
Above: Tendon reflex test of the muscles around the elbow1-2 weeks
The main goals of your physiotherapy treatment immediately after lateral epicondylitis release surgery is to control pain and swelling as well as reducing stiffness in an aim to maintain mobility and range of movement. Your Physiotherapy will secondly focus on improving strength in your fingers, wrist, shoulder and unaffected arm for extra support for your elbow joint. Your physiotherapy will include:
- Ice (treat pain and swelling)
- Elevation
- Compression
- Pain killers (control pain)
- Movement of wrist and fingers
- Passive range of movement exercises - may be placed on continuous passive motion machine (CPM)
- Strengthening and stretching exercises for wrist, shoulder and unaffected arm for support
- Arm can be used for light activity only
2-6 weeks
After 2 weeks of recovery post lateral epicondylitis surgery your physiotherapy programme will continue to control pain and swelling you are experiencing as well as reducing stiffness in your elbow and arm. At this stage Physio.co.uk will now aim to include strengthening activities and various range of movement exercises to improve function in your elbow joint. Your physiotherapy programme will also continue to focus on strengthening and improving range of movement and functioning within your fingers, wrist, shoulder and unaffected arm. Your physiotherapy during this period will include:
- Modalities for pain control
- Cryotherapy (ice), elevation and compression
- Passive (assisted) range of movement exercises (bending, straightening, twisting)
- Gentle active (on your own) and active assisted (some assistance) range of movement exercises (bending, straightening, twisting)
- Stretches for muscles around elbow
- Gentle strengthening exercises for major muscle groups around elbow
- Strengthening and stretching exercises for wrist, shoulder and unaffected arm for support.
Above: Passive stretch of muscles and connective tissue of the uppper arm6-12 weeks
During the later stages of your rehabilitation after lateral epicondylitis release surgery you will have seen marked improvements in range of movement, strength and function within your elbow joint. Your physiotherapy programme with Physio.co.uk will continue to focus on maximising the mobility and range of movement in your elbow as well as increasing the strength and muscle control in the muscles around you affected elbow, wrist, shoulder and unaffected arm. Exercises will also aim to improve fine motor control and dexterity of the hand to further maximise function within your affected upper limb. Additionally, the goals of your physiotherapy with Physio.co.uk at this stage will be directed towards activities that improve your cardiovascular fitness and muscle endurance. There will also be emphasis on activities that are specific to everyday tasks and your job, hobby or sport. Your therapist will also provide you with exercises that you will be encouraged to do at home. Your physiotherapy will include:
- Continuation of modalities to control for pain and swelling (Ice, elevation, compression)
- Passive and active range of movement exercises for elbow and wrist (bending, straightening, twisting)
- Strengthening exercises for muscles around elbow joint (biceps, triceps etc)
- Hand squeezing exercises (putty/sponge)
- Upper limb mobility exercises
- Stretching exercises to increase flexibility
- Strengthening exercises for muscles in wrist, hand and shoulder
- Activities for opposite arm
- Static arm cycle
- Hydrotherapy
- Functional activities relative to job, hobby or sport
- Emphasis on independent home exercises
Summary
Lateral epicondylitis release is a surgical procedure to treat problems caused by lateral epicondylitis, a condition more commonly known as tennis elbow. Tennis elbow is most commonly caused by overuse of the muscles and tendons of the forearm and elbow which causes tissue damage and inflammation around the outer part of the elbow joint. Lateral epicondylitis release surgery aims to remove any damaged tissues and consequently reduce inflammation. Lateral epicondylitis release surgery alleviates symptoms such as pain, stiffness and reduced upper limb function that are a result of tennis elbow. Physiotherapy after a lateral epicondylitis release is essential to maximise the success of the surgery and to achieve full or near to full function in the elbow joint. It is also necessary to undergo physiotherapy post lateral epicondylitis release surgery to ensure a rapid recovery and to help prevent problems associated with tennis elbow in the future. Physio.co.uk offers a comprehensive physiotherapy course that will help you achieve all your rehabilitation goals and get you back to your everyday tasks, job, hobby or sport. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment please contact us.
