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Surgery for tennis elbow offers no additional benefit, study suggests

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Tennis elbow, also known as lateral epicondylitis or lateral epicondylalgia, is a condition where there is pain on the outside of the elbow. It is usually treated with rest, stretching, physiotherapy and, occasionally, steroid or PRP (Platelet Rich Plasma) injections.

Surgery is considered in rare cases, but a new Australian study suggests that surgical approaches to treating tennis elbow may not offer patients any additional benefit.

The research findings were presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day in San Diego.

The randomised, double-blinded clinical trial looked at patient responses to a common surgical procedure aimed at repairing a damaged elbow, compared to a placebo procedure. Participants in the trial had experienced symptoms of tennis elbow for more than six months, and attempted at least two non-surgical treatment approaches such as physical therapy, massage, acupuncture, or splinting/bracing, but had no symptom relief over that period.

Thirteen patients underwent surgery to remove a degenerated portion of their extensor capri radialis brevis (ECRB), while another 13 received an incision over their lateral elbow and no further repair. The two groups were treated with the same rehab, including ice application, stretching and a strengthening programme within two weeks of surgery.

Both the surgery and placebo procedures improved patient-rated pain frequency and severity, elbow stiffness, difficulty with picking up objects, twisting motions and overall elbow rating at six months. These results were consistent or improved after 1-4 years of follow-up, with no significant difference between the two groups at any stage, said lead author Dr Martin Kroslak from the Orthopaedic Research Institute in Sydney, Australia.

“Managing chronic tennis elbow is a challenge for a large portion of the active population,” Dr Kroslak commented. “Our research demonstrates the challenges in outlining a treatment plan for these patients, and the continued work to be done in developing both surgical and non-operative approaches.”