Many doctors feel that
micro tears in the tendon lead to a hyper-vascular phenomenon resulting
in pain. The pain is usually worse with strong gripping with the elbow
in an extended position, as in a tennis back hand stroke, but this problem
can occur in golf and other sports as well as with repetitive use of tools.
Before surgery is considered a trial of at least six months of conservative
treatment is indicated and may consist of a properly placed forearm
brace and modification of elbow activities, anti-inflammatory medication
and physical therapy. If the above treatment is not helpful,
a cortisone injection can be beneficial but no more than three
injections are recommended in any one location in a year.
Conservative treatment is in two phases and after Phase I (Pain
relief) has been successful, Phase II (Prevention of recurrence) is equally as important and involves stretching and then later strengthening
exercises, so the micro tears will not occur in the future.
When conservative
treatment has failed, then surgery is indicated. Many procedures
have been described. Procedures as simple as percutaneous release of the
tendon off of the bone have been described and more recently arthroscopic procedures or other procedures involving the joint and resection of a
ligament as well have been described.
The most popular
procedure today is a simple excision of diseased tissue from within the
tendon, shaving down the bone and re-attachment of the tendon. This can
be performed as an outpatient procedure with regional anesthesia (where
only the arm goes to sleep) and through a relatively small incision of
approximately 3” long. 85-90% of patients with this technique are
typically able to perform full activities without pain after a recuperation
of two to three months. Approximately 10-12% of patients have improvement
but with some pain during aggressive activities and only 2-3% of patients
have no improvement.
