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I am going to see my surgeon next week about having something done on my elbow. I haven't been able to golf for months now because of tennis elbow (well, I guess they call it golfer's elbow when you golf). What kind of surgery can they do for this problem?

When the inside of the elbow develops a painful problem, it's usually called medial tendinitis or "tennis elbow". When the side away from the body is affected, the label given is lateral epicondylitis or "golfer's elbow". In either case, the problem is given the -'itis' ending when it is an acute (just developing) problem. When it becomes a chronic problem that lasts for months or more, then it's not really a tendinitis as much as it is a tendinopathy. Tendinopathy refers to the fact that tissue samples taken of tendons on the affected side of the elbow show no inflammation at all. Scarring and fibrosis can be seen on microscopic exam but there are no signs of acute tendon damage or healing. Unless you have tried nonoperative methods of treatment, surgery may not be the right choice for you. Most surgeons recommend at least a three (sometimes six) month trial of conservative care. This might include steroid injections, physical therapy, bracing, and activity restriction or modification. Many patients improve enough with this type of treatment that they can avoid surgery. Surgery is usually not considered until and unless the patient has had extensive nonoperative care that has failed to change the symptoms or improve function. When surgery is indicated, the surgeon has many options to choose from: muscle resection, debridement (shaving away frayed edges), reattachment of torn tendons to the bone, repair with tendon grafts, release of tendons, and combinations of these treatments. The specific approach will depend on the type of soft tissue damage present, your activity level, and your overall health. Problems like high blood pressure, diabetes, or heart disease can have a bearing on the type of surgery you can handle. Once your surgeon evaluates you, the treatment of choice will likely become clear.

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