Surgery for refractory lateral epicondylitis of elbow?

First off, surgery is not the first answer for tennis elbow (lateral epicondylitis). In normal adults, inflammation of the common extensor origin may arise insidiously and can persist for several months. In most adults, the condition is self limited and usually resolves within a year. More invasive treatment options include oral anti-inflammatory medications (NSAIDS), therapy, steroid injections, and again... Time. When these fail, surgery becomes an option.

Surgical release of the common extensor origin has a 90% good to Excellent result. This may be accomplished via an open approach in which a small incision (5 cm) is made over the origin of the common extensor wad, just distal to the lateral epicondyle. The "bad" tissue is excised and the tendon is repaired with suture. The arm is protected from forceful wrist extension for 4 weeks, but one can often return to light duty within a couple of days.

The same procedure can be performed arthroscopically, however, a slightly increased risk of nerve injury exists with elbow arthroscopy. It is also more technically demanding as one must avoid injury to the lateral collateral ligament of the elbow.