Overview
Tennis elbow and golfer's elbow are the same problem on opposite sides of the joint. The wrist extensor tendons anchor to the outer bump of the elbow (lateral epicondyle) and the flexor tendons to the inner bump (medial epicondyle). Under years of gripping load, a patch of tendon at that anchor, most often the extensor carpi radialis brevis (ECRB) on the outside, degenerates into disorganized, painful tissue that does not heal. Release surgery removes that patch and reattaches healthy tendon to bone.
The operation is for the minority whose elbow has not settled with time and rehabilitation. For that group it reliably relieves the gripping pain, with full painless function typically by three to six months. It is a short outpatient procedure at Bayside Surgery Center in Coconut Grove.
Who It's For
About nine in ten cases of tennis or golfer's elbow resolve without surgery, so Dr. O'Donnell operates only after six to twelve months of proper non-operative care has failed: activity modification, a counterforce strap, an eccentric strengthening program, and usually an ultrasound-guided injection. Surgery is considered when pain still limits work or sport after that, the exam still reproduces sharp pain at the epicondyle with resisted wrist extension or flexion, and MRI or ultrasound shows a defect in the tendon origin.
Patients with symptoms for less than six months, or who have not completed an eccentric loading program, are better served by finishing it; Dr. O'Donnell's lateral and medial non-operative protocols lay it out. On the inner elbow, tingling in the ring and little fingers or ligament instability in a throwing athlete point to cubital tunnel syndrome or a UCL injury rather than golfer's elbow.
A tendon defect on MRI or ultrasound is not by itself an indication for release; such changes are common in painless elbows. Dr. O'Donnell operates only when the tenderness at the epicondyle, pain with resisted wrist extension or flexion, and the imaging all point to the same tendon origin, and six to twelve months of correct non-operative care have failed. See the tennis and golfer's elbow page.
What the Procedure Involves
The operation takes about 30 to 45 minutes under a regional nerve block with sedation. For tennis elbow Dr. O'Donnell uses either an open or an arthroscopic technique. Open release is done through an incision of about 3 cm over the lateral epicondyle. The extensor origin is split in line with its fibers, the degenerated grey tissue at the base of the ECRB is excised back to healthy, glistening tendon, the bone is lightly roughened to bring in a blood supply, and the healthy tendon is reattached to bone with a suture anchor.
Arthroscopic release does the same job from inside the joint through two small portals: the capsule and ECRB origin are released from the bone under direct vision, which also lets Dr. O'Donnell check the joint for a plica or cartilage wear that can mimic tennis elbow. The arthroscopic approach has a smaller scar and quicker early recovery; the open approach allows more thorough removal of diseased tissue and a formal repair, and is preferred when imaging shows a large defect or partial tear. Golfer's elbow is treated open through an incision over the medial epicondyle with the same debride-and-reattach sequence; the ulnar nerve sits just behind the incision and is protected throughout.
A soft dressing or light splint goes on and you go home the same day with the fingers free to move.
Risks & How They Are Minimized
Infection is uncommon and covered by an antibiotic before the incision and a dry dressing for 48 hours. The specific risk on the outer elbow is damage to the lateral collateral ligament, which lies immediately behind the extensor origin; removing too much tissue can leave the elbow subtly unstable. Dr. O'Donnell limits the debridement to the ECRB origin and leaves the ligament untouched. On the inner elbow the ulnar nerve and medial collateral ligament are protected by keeping the release in front of the epicondyle.
Persistent pain is the most common poor result of this operation, usually because something else was contributing, such as a plica, radial tunnel syndrome or neck-related pain; the pre-operative exam and imaging are meant to rule those out first. Grip weakness persists for a few months while the reattached tendon matures, which is why resisted wrist extension is held back for six weeks. Stiffness is rare and is prevented by early motion. Blood clots after arm surgery are rare and need no routine medication.
Recovery & Rehabilitation
The postoperative protocol protects the reattached tendon for six weeks, then rebuilds load tolerance in the same eccentric fashion used in non-operative care. The medial side follows the same schedule with the wrist flexors in place of the extensors.
| Phase | Timing | What happens |
|---|---|---|
| Protection | Weeks 0–2 | Splint or soft dressing. Gentle active wrist, finger and elbow motion, elevation and ice. No resisted wrist or forearm activity. |
| Motion | Weeks 2–6 | Full active elbow, wrist and forearm motion; gentle wrist extensor and flexor stretching; scar mobilization. Still no resisted wrist extension or forceful gripping. |
| Strengthening | Weeks 6–12 | Wrist extensor strengthening progressed from isometric to eccentric to concentric; grip strengthening; forearm and shoulder-girdle conditioning. |
| Return to activity | Months 3–6 | Sport- or job-specific progression and a maintenance program. Full work and sport once function is painless and strength is symmetric. |
Desk work is possible within a few days; driving once you are off narcotic pain medication and can grip the wheel comfortably, usually one to two weeks. Racquet sport, golf and manual work that involves gripping return during the strengthening phase and are unrestricted by three to six months.
Protocol summary
The precautions are a splint or soft dressing for one to two weeks, no resisted wrist extension or forceful gripping for six weeks, and protecting the incision while swelling settles. Gentle wrist, finger and elbow motion starts immediately.
Progression is criteria-based: wound healing and controlled pain to leave Phase I, full pain-free motion with a well-healed, mobile scar to leave Phase II, and grip strength improving toward symmetric to leave Phase III. Full painless function and symmetric strength are the criteria for unrestricted work and sport. Dr. O'Donnell adjusts the pace based on what the tendon looked like at surgery.
Physical Therapy Protocol
Lateral Epicondylitis — Postoperative Management PDF ↗Frequently Asked Questions
When should I consider surgery for tennis elbow?
After six to twelve months of proper non-operative treatment has failed and the pain still limits your work or sport. Proper treatment means an eccentric strengthening program, a counterforce strap, activity changes and usually an injection, not just rest. About nine in ten patients get better without surgery.
Is tennis elbow surgery open or arthroscopic, and which is better?
Both remove the degenerated tendon at the outer elbow. Arthroscopic release uses two small portals, allows the joint to be inspected, and has a quicker early recovery. Open release through a 3 cm incision allows more thorough removal of diseased tissue and a formal repair to bone, and is preferred when imaging shows a large defect or partial tear.
How long is recovery after tennis elbow release?
Motion begins immediately and a splint, if used, comes off within two weeks. Resisted wrist extension and strong gripping are held back for six weeks while the tendon heals to bone, then strengthening runs to three months. Most patients are back to unrestricted work and sport between three and six months per the postoperative protocol.
When can I play tennis or golf again after elbow surgery?
Light hitting or chipping can usually begin around three months, once grip strength is improving and the elbow is pain-free through a full swing. Full competitive play typically follows between four and six months. Returning earlier, before the tendon can tolerate eccentric load, is the most common reason for a flare after surgery.
Is golfer's elbow surgery the same as tennis elbow surgery?
The principle is the same: remove the degenerated tendon at the epicondyle and reattach healthy tendon to bone. Golfer's elbow is treated open through an incision on the inner elbow, and the ulnar nerve, which runs just behind it, is identified and protected. Rehabilitation follows the same timeline with the wrist flexors taking the place of the extensors.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.