Elbow surgery in Enfield

Three bones come together to form your elbow joint:

• Your humerus (the long upper arm bone)
• Your radius (the forearm bone on the thumb side)
• Your ulna (the forearm bone on the pinky side)

The bony tip of the elbow located at the end of the ulna is called the olecranon. A small, fluid-filled sac called a bursa covers the olecranon.

The elbow joint is held together and kept stable by the bony structures of these three bones as well as:

• Muscles
• Ligaments (which connect bone to bone)
• Tendons (which connect muscle to bone)

The surfaces where the bones meet are covered with a thin layer of protective cartilage.

You also have three major nerves that cross the elbow: the ulnar nerve, median nerve and radial nerve.

If you have a problem with any of these components, you might experience elbow pain, stiffness, instability, tingling or numbness.

Elbow surgery is often required after a traumatic elbow injury, including fractures, complex fractures, dislocations or fracture-dislocations. Anyone of any age can suffer from a traumatic elbow injury. They can result from a fall, direct impact to the arm, sports injury or a car crash. Often you can experience more than one elbow injury in the same accident.

Below, we’ll take a look at some other common elbow injuries that might require elbow surgery, including:

• Tennis elbow
• Golfer’s elbow
• Cubital tunnel syndrome
• Olecranon bursitis
• Elbow stiffness and arthritis

What are non-surgical treatments for elbow pain?

For all of the injuries above — excluding the complex trauma injuries — non-surgical treatments would be explored first.

In most cases, elbow injuries respond well to anti-inflammatory painkillers, bracing, physiotherapy, injections or activity modification.

It is caused by forceful and repetitive movements that cause inflammation or microtears to the tendon connecting the forearm muscle to the outside of the elbow. Tennis elbow is felt as pain and tenderness on the outside of the arm that may travel down the forearm or pain when bending the wrist backwards.

Does tennis elbow require surgery?

Mr Simond Jagernauth, Consultant Upper Limb Orthopaedic Surgeon at The Cavell Hospital in Enfield, explains how surgery is only a last resort for tennis elbow and most other conditions:

“There’s a ladder of treatment options available. This starts with simple painkillers and anti-inflammatory medications and the use of an off-loading tennis elbow brace. Other options include shockwave therapy, needling or injections with steroids or PRP. Patients tend to do well with physiotherapy — surgery is the last resort. Most patients will get better with non-operative management.”

In most cases, physiotherapy and platelet-rich plasma (PRP) injections are highly effective in treating tennis elbow.

If all available non-surgical options have been exhausted and you are still experiencing pain and stiffness, your consultant might recommend surgery. You would make this decision after discussing the risks and benefits with your orthopaedic surgeon at The Cavell Hospital.

What to expect from tennis elbow surgery

Tennis elbow surgery is sometimes called tennis elbow release. Tennis elbow release at The Cavell Hospital is a day case surgery, which means that you will come into the hospital for your surgery and leave the same day.

Most tennis elbow releases are done as traditional open surgeries, but they can be performed with keyhole surgery. Your orthopaedic surgeon will make an incision over your injured tendon, remove the damaged parts of the tendon and muscle and stimulate bone healing before repairing the tendon and stitching up the incision.

Your consultant at The Cavell Hospital will discuss the options, benefits and risks of tennis elbow release surgery with you.

How long to recover from tennis elbow surgery

Recovery time will vary, but generally, you will return to the hospital two weeks after your surgery to check the wound and follow up with your consultant.

Tennis elbow release is typically a highly successful surgery, with individuals experiencing pain relief and the ability to return to sporting activities within four to six months.

Symptoms of golfer’s elbow are pain on the inside of the forearm that may radiate down the arm, burning pain and weakness of grip.

Does golfer’s elbow require surgery?

Like tennis elbow, surgery for golfer’s elbow is only recommended after all other treatment options have been tried and failed.

Non-surgical treatment options for golfer’s elbow include:

• Rest
• Activity modification
• Physiotherapy
• Needling
• Steroid injections
• PRP injections

What to expect from golfer’s elbow surgery

Golfer’s elbow release is performed as traditional open surgery. Like tennis elbow release, it is done as a day case surgery, and you will be given general anaesthesia for the procedure.

Your orthopaedic surgeon will remove damaged portions of the tendon, remove any bone spurs or damaged tissues, stimulate growth in the bone and re-attach the tendon to the bone. They will then close the wound with stitches.

Two weeks after your surgery, you will return to The Cavell Hospital to have your wound checked. It’s also critical to follow your personalised physiotherapy programme to maximise the success of your operation. You will be advised to avoid heavy lifting until cleared by your physiotherapist.

Golfer’s elbow surgery recovery time

Recovery times will vary, but most patients can fully return to their usual activities within four to six months after surgery.

Symptoms of cubital tunnel syndrome are similar to the feeling you get when you hit your ‘funny bone’, which is actually your ulnar nerve. They might include:

• Numbness and tingling in the hand, especially in the ring and pinky fingers
• Hand pain
• Weakening of your hand grip
• Aching pain in the inside of your arm

Your consultant will first recommend various non-surgical treatments for cubital tunnel syndrome, including activity modification, sleeping with a splint or brace to keep your elbow straight at night, anti-inflammatory painkillers and physiotherapy.

However, if these treatments have not worked for you, or you have muscle weakness or damage, then surgery may be recommended.

Mr Jagernauth explains how some cases might require prompt surgery:

“If cubital tunnel syndrome goes untreated and symptoms progress, this can lead to persistent numbness and weakness of the hand. If non-operative measures aren’t helping, I try to perform surgery before patients find themselves in the advanced stage of the condition as it can otherwise be difficult to reverse their symptoms.”

What is surgery for cubital tunnel syndrome?

Cubital tunnel release surgery is when pressure is relieved from the ulnar nerve by increasing the size of the cubital tunnel where the ulnar nerve passes.

Occasionally, a surgery called ulnar nerve anterior transposition is required because the nerve is unstable after it is decompressed. In this surgery, your orthopaedic surgeon moves the ulnar nerve from behind the medial epicondyle (the bony bump of the elbow) to the front of the elbow.

Surgeries for cubital tunnel syndrome are performed as day cases. This may be done with sedation or general anaesthesia, and you might require painkillers for the first week after the surgery. Physiotherapy is not usually needed after the surgery, but you will be encouraged to move your elbow after the operation.

Simple measures such as using an elbow cushion, taking anti-inflammatory drugs and activity modification should help moderate cases. If the bursa is infected, the fluid would be drained with a needle, and you would be given antibiotics. Additional treatments could include corticosteroid injections.

When is surgery needed for elbow bursitis?

Surgery would be recommended in rare cases where non-surgical methods have not helped. Mr Jagernauth explains how surgery helps patients with olecranon bursitis:

“The olecranon bursa is a fluid-filled sac that overlies the end of the olecranon bone. Sometimes it can become inflamed, leading patients to notice pain and swelling. It can occur after an injury or even after prolonged leaning on the elbow. Patients may first notice it following an infection.  There may be an underlying bone spur that develops, and some patients, despite measures such as an aspiration or steroid injection and physio, still have pain and swelling. In these cases, we may consider an excision of the olecranon bursa and the underlying bone spur to relieve the condition.”

Once the bursa and any additional bone spurs have been removed, the bursa will slowly grow back over the following months.

Formal physiotherapy is not typically needed, but you might be given some simple exercises to do at home following your surgery.

• Previous fractures and dislocations
• Previous elbow surgeries
• Loose bodies (small fragments of bone or cartilage that float in the joint)
• Growth of bone spurs
• Arthritis

Elbow stiffness is not only uncomfortable, but it can prevent you from doing your everyday activities as you would like.

For those patients who have explored physiotherapy and other treatments and are still unable to achieve a full range of movement, a surgical procedure to release the stiff elbow might be recommended.

What is elbow release surgery?

Elbow release surgery (also called arthrolysis) can help you regain full movement in your elbow again. Some surgeries are done as arthroscopic (keyhole) procedures, but often, you will need open surgery. Your consultant will discuss the benefits and risks of each type of surgery with you. 

Different methods of performing a stiff elbow release depend on the cause of the stiffness. In arthroscopic surgery, small incisions are made, and the loose bodies can be removed and tissues released.

In other cases, scar tissue and bony growths (bone spurs) may need to be removed via open surgery to improve elbow mobility.

Elbow replacement surgery

For those patients in advanced stages of arthritis whose joint surfaces have worn away completely, a total elbow replacement surgery might be recommended.

This is a specialist surgery in which the damaged parts of your elbow joint are replaced with an artificial elbow.

Total elbow replacement is not a common surgery — it is often recommended for older patients with severe osteoarthritis, rheumatoid arthritis or post-traumatic arthritis.

After your surgery, you will be given painkillers to help relieve pain. A nurse will advise you on how to take care of your dressings and avoid getting them wet.

For the first few nights after surgery, it is recommended that you sleep with your arm elevated above the level of your heart to prevent swelling in your hands and fingers.

Physiotherapy is tailored to your specific condition, but there is a structured programme of physical therapy exercises for tennis elbow and golfer's elbow.

Your physiotherapist will advise you on what you can and cannot do. Heavy lifting, for example, should be avoided after surgery as it will exacerbate pain and discomfort in the elbow.

You will generally return to The Cavell Hospital two weeks after your surgery to see your consultant, who will remove your stitches and inner dressings. After this, you should be able to shower without the risk of infection to your wound.

You cannot safely drive until your bandages and sling have been removed, and you may need to wait additional time until your arm is strong enough to control the steering wheel.

Your consultant will advise you on when you can return to your various everyday activities.

The benefits of choosing The Cavell Hospital for your elbow surgery include:

• Consultant-led care by an experienced orthopaedic surgeon
• A tailored approach from diagnosis to treatment and post-operative care
• Personalised physiotherapy programmes designed to maximise your recovery and healing process
• The flexibility to book your surgery around your life
• An expert team of nurses, radiologists, orthopaedic surgeons, and physiotherapists that works together for your care.

Choosing the right hospital for your elbow surgery is paramount.

Mr Jagernauth says, “At Cavell Hospital, our staff are caring and compassionate and strive to provide the best outcomes for our patients. We aim to diagnose conditions promptly and treat patients using the latest available techniques, tailored to their individual needs.”

Your consultant at The Cavell Hospital will discuss if elbow surgery is right for you. Elbow surgery can provide freedom from pain, stiffness and limited mobility.

The Cavell Hospital is located at Cavell Drive, Uplands Park Road, Enfield, London, EN2 7PR.

You can book a rapid appointment with one of our orthopaedic surgeons today, or call us at 020 8366 2122.