The Elbow

Tenniselbow / Type II

Tenotomy

Despite a consistently applied treatment, a type 2 elbow can still relapse.
A percutaneous tenotonomy can then solve the problem.

Procedure :

First the skin and the tener part of the tendon is infiltrated with +/- 1 cc Xylocaine using the same injection technique as for the treatment.
Afterwards the tendon is cleaved diagonally with a narrow tenotonomy knife
Finally a Mill's manipulation is carried out.

The intervention is done ambulant and apart from a fortnights relative rest the patient doesn't need any special after-treatment.
After a fortnight the resisted extension is retested on pain.

If the pain is still present, another infiltration of one cc triamcinolone should be given at the tender spot, which is usually localised at the periosteal end of the cut.

Rationale
The treatment imitates the mechanism of spontaneous cure: separation of the inflamed tendon (cfr spontaneous cure)
The two surfaces of the cut cease to lie in apposition and the tension on the scar eases. Later on the space is filled with fibrous tissue so that the scar heals with a permanent lengthening.

Results
This simple operation, performed on a an ambulant patient good results are reached in about 50% of long-standing and refractory tennis elbows.