TENNIS ELBOW TREATMENT MELBOURNE

Dr Christopher Pullen

Tennis Elbow Treatment Melbourne

A Patient’s Guide:

 Dr Christopher Pullen – BSc(Hons), MBBS, MPH, FRACS, FAorthoA.
Orthopaedic Surgeon

“I may recommend surgical treatment if you have a painful elbow condition that does not respond to nonsurgical treatment including rest, physical therapy, medications and injections.

Prior to recommending surgery, I will undertake a thorough clinical examination, discuss your diagnosis and detail the treatment options to ensure you understand the benefits and potential complications.”

PATIENT CARE PROCESS – DR CHRISTOPHER PULLEN
Dr Pullen’s approach to your care:

1. First Appointment

Referral, consultation & testing.

2. Diagnosis

Diagnosis & treatment options.

3. Treatment Plan

Non-operative VS operative.

4. Follow up & care plan

Monitoring, pain relief & care plan.

ELBOW JOINT ANATOMY

The anatomy and function of your elbow joint

The elbow is a complex hinge joint that actually consists of three separate joints. These joints allow for a wide range of movements of the forearm and hand. Many of the muscles of both the upper and lower arm either cross or attach to at least one component of the elbow joint.

The elbow joint is made up of three bones, (1) the humerus, (2) ulna, and (3) radius. It is surrounded by a watertight sac called the joint capsule (which is filled with lubricating fluid).

The main ligaments of the elbow are the:
(1) Medial collateral ligament (on the inner side of the elbow) – connects the ulna to the humerus.
(2) Lateral collateral ligament (on the outer side of the elbow) – connects the ulna to the humerus.
(3) Annular ligament, holds the radial head tight against the ulna.

There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm begin their course. The bony bump on the outer side (lateral side) of the elbow is called the lateral epicondyle.

Tennis Elbow involves the muscles and tendons of your forearm that attach to the lateral epicondyle.This attachment is called the common extensor origin.

Elbow Joint Anatomy

Tennis elbow

Figure 1

TENNIS ELBOW

Tendon Tears

Tennis elbow (also known as Lateral Epicondylitis) is a type of tendinitis (swelling of the tendons) or micro-tearing of the tendons that causes pain on the outer side of the elbow and forearm.

Elbow tendons are the bands of tough tissue that connect the muscles in your elbow joint to the bones in your arm.

Tennis elbow is caused by repetitive gripping activities of your hand wrist and forearm such as gardening, painting, racquet sports, carpentry or computer use. Symptoms may include soreness and tenderness to touch on the outside of the elbow, swelling of the area, weakness or stiffness in the forearm. It may hurt to do certain movements and the pain may become severe.

To diagnose tennis elbow, Dr Pullen will do a thorough exam including the flexing of your arm, wrist, and elbow to see where it hurts. You may also need imaging tests, such as an X-ray or MRI (magnetic resonance imaging) to diagnose tennis elbow or rule out other problems.

Tennis Elbow Treatment

TENNIS ELBOW SURGERY

If your symptoms do not respond to nonsurgical treatments, Dr Pullen may recommend surgery. Most surgical procedures for tennis elbow involve removing diseased tendon and reattaching healthy tendon back to bone.

The right surgical approach for you will depend on a range of factors including the scope of your injury, your general health, and your personal needs.

Dr Pullen will discuss the options with you and any risks associated with each of the following procedures:

(1) Arthroscopic surgery – Dr Pullen will usually make two small incisions (cuts), about half a centimetre long, around the joint. He will insert and arthroscope (small camera) through one of the incisions so he can examine the joint. Through the other incision he will insert surgical instruments to help remove and or repair the damaged part of the tendon and potentially treat any other problems with the joint.

(2) Open surgery – The operation is similar but is performed through a 4 to 5 centimetre cut made on the outer sideof your elbow.

Tennis Elbow Surgery

AFTER TENNIS ELBOW SURGERY

What happens after surgery?

After the surgery you will wake up in recovery with your arm in a sling or cast. Dr Pullen will see you to discuss the results of the surgery. Your elbow will be swollen and painful and you will be given painkillers and an ice pack regime to help ease the pain.

Usually you will need to stay in hospital overnight. Most patients can go home the next day.

The next morning your bandages will be changed and a physiotherapist will see you and tell you which exercises and activities you may undertake to help your recovery. You can shower but must keep the wounds dry.

Pain relief – It is normal to have pain after surgery and painkillers will be given to you during your hospital stay and to take home. Your pain will slowly reduce over time.

After your surgery – Do not attempt to lift or rotate the arm. During the first 2 weeks after the operation it is important that the repaired muscles do not contract when the elbow is moved as the repair may be torn apart.

An appointment will be organised for you to see Dr Pullen in 10 to 14 days after your surgery.

TENNIS ELBOW SURGERY – RECOVERY TIMELINE

The recovery period varies from patient to patient and depends on the nature and complexity of the surgery. A typical recovery timeline may include:

Timeline – After surgeryDescription
0  to 2 weeksYou’ll be given a course of antibiotics and pain relief medicine immediately after your surgery. Your arm will be in a splint or cast to help restrict movement and protect the elbow allowing the operation site to heal. In the first month after surgery, expect to have someone assist you with tasks around the home as you won’t have full use of your injured arm.
2 to 4 weeks During the first 2 to 4 weeks after the operation it is important that the repaired muscles do not contract when the elbow is moved as the repair may be torn apart. Activities related to your elbow rehabilitation will be the focus. Dr Pullen and your physiotherapist will discuss the with you in detail.
3 to 6 monthsIt usually takes between 3-6 months after surgery to achieve a significant end range strength, power, and endurance back into your elbow. Sports and lifting heavy objects will need to be delayed for 3 to 6 months.

Please contact my office or your general practitioner if after surgery you have:

  • Severe pain that is not helped by the pain medication you have been given
  • Redness or swelling around the wounds
  • Fever, sweats or chills.

POTENTIAL COMPLICATIONS

The risks and complications of tennis elbow surgery include:

  • Elbow stiffness and restricted movement
  • Infection
  • Numbness or tingling around the elbow and forearm
  • Recurrent tendon tear
  • Persistent elbow and forearm pain.

Dr Pullen will discuss with you in detail the potential complications and risks in relation to the surgery.

Mr Troy Keith
Dr Christopher Pullen
BSc(Hons), MBBS, MPH, FRACS, FAorthoA.
Orthopaedic Surgeon

If you have any questions please contact my team:

 Tennis Elbow Surgery Melbourne:

Dr Christopher Pullen – Orthopaedic Surgeon

If you have any questions or would like to make an appointment, please feel free to contact my team:

Proud member of Royal Australasian College of Surgeons and Australian Orthopaedic Association.

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Tennis Elbow Surgery Melbourne

Dr Pullen treats patients from all over Victoria in relation to elbow injuries. He consults with patients at the following practice locations in Melbourne including East Melbourne and Ringwood.