Name of the Procedure:

Tenotomy, elbow, lateral or medial (e.g., epicondylitis, tennis elbow, golfer's elbow); percutaneous

Summary

In layman's terms, this procedure involves making a small incision through the skin to cut the tendon in the elbow that is causing pain, often for conditions like tennis elbow or golfer's elbow. The procedure is done using a needle and minimal invasion, which means less pain and quicker recovery.

Purpose

The medical conditions this procedure addresses include:

• Lateral Epicondylitis (Tennis Elbow)
• Medial Epicondylitis (Golfer's Elbow)

The goals are to alleviate pain, improve elbow function, and enable the patient to return to daily activities without discomfort.

Indications

This procedure is indicated for patients who:

• Experience chronic pain in the elbow despite conservative treatments like medications, physical therapy, and bracing.
• Have pain that interferes with daily activities or sports.
• Show evidence of tendon damage or degeneration on imaging studies.

Preparation

Patients may need to:

• Fast for a few hours before the procedure if sedation is planned.
• Adjust or stop certain medications, especially blood thinners.
• Undergo pre-procedure diagnostic tests like MRI or ultrasound to assess the tendon condition.

Procedure Description

1. The patient is positioned comfortably, usually lying down.
2. The area around the elbow is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. A small needle is inserted into the skin over the affected tendon.
5. Using ultrasound guidance, the surgeon makes precise cuts in the tendon to release tension.
6. The needle is removed, and a small dressing is applied.

Tools used include:

• Needle
• Ultrasound machine

Duration

The procedure typically takes about 20 to 40 minutes.

Setting

It can be performed in an outpatient clinic or a surgical center.

Personnel

• An orthopedic surgeon or a specially trained physician
• A nurse or medical assistant for support
• An anesthesiologist if sedation is used

Risks and Complications

Common risks:

• Pain and swelling at the procedure site
• Minor bleeding or bruising

Rare risks:

• Infection
• Nerve or blood vessel damage
• Incomplete relief of symptoms

Benefits

• Pain relief within a few weeks to a couple of months
• Improved function and range of motion in the elbow
• Minimally invasive with quicker recovery times compared to open surgery

Recovery

• Keep the elbow elevated and apply ice to reduce swelling.
• Avoid strenuous activities and lifting for several weeks.
• Follow-up appointments to monitor progress.
• Physical therapy may be recommended to strengthen the muscles around the elbow.

Alternatives

Other treatment options include:

• Physical therapy and exercise regimens
• Anti-inflammatory medications
• Steroid injections
• Extracorporeal shockwave therapy (ESWT)
• Open surgical release

Each alternative comes with its own benefits and drawbacks, often depending on the severity of the condition and patient preferences.

Patient Experience

During the procedure, the patient will feel minimal discomfort due to local anesthesia. Post-procedure, there might be mild pain and swelling. Pain management includes over-the-counter pain relievers and ice application. The overall recovery is relatively swift, with many patients experiencing significant pain relief within a few weeks.