What is a Common Extensor Tendon Origin Repair?
The common extensor tendon is a tough band of fibrous connective tissue that attaches to the lateral epicondyle of the humerus (long bone in the upper arm) at the elbow. Rupture or tear of the common extensor tendon is the most common acute tendon injury of the elbow. The most frequent pathology of the common extensor tendon is epicondylitis and is characterised by loss of normal tendon structure.
A surgical or conservative approach is employed to treat injuries of the common extensor tendon origin such as Tennis elbow/lateral epicondylitis. Tennis elbow and golfer’s elbow are similar, except that golfer’s elbow occurs on the inside of the elbow (medial epicondylitis) and tennis elbow occurs on the outside of the elbow (lateral epicondylitis). Tennis elbow is an overuse injury of the common extensor tendon origin. The common extensor tendon originating from the lateral epicondyle of the elbow is directly involved in Tennis elbow.
Causes of Common Extensor Tendon Origin Rupture
Any recreational or occupational activity that involves extensive use of the common extensor tendon can result in tennis elbow or lateral epicondylitis. It is commonly seen in individuals between the ages of 30 and 50. Common causes may include:
- Activity that requires repetitive motion of the forearm such as painting, typing, weaving, gardening, lifting heavy objects, and sports.
- Overuse of the forearm muscles.
- Direct trauma as with a fall, work injury, or motor vehicle accident.
- Poor grip when playing racket sports.
- Weakened muscles of the shoulder and wrist.
Symptoms of Common Extensor Tendon Origin Rupture
Signs and symptoms of common extensor origin rupture may include:
- Elbow pain that gradually worsens
- Pain at the outside of the elbow that radiates to the forearm and wrist when grasping objects
- Weak grip
- Painful grip
- Exacerbated pain in the elbow when the wrist is bent back
Diagnosis of Common Extensor Tendon Origin Rupture
Your doctor will evaluate the rupture by reviewing your medical and occupational history, performing a thorough physical examination, and ordering X-rays, MRI or electromyogram (EMG) to rule out any fracture, soft tissue injury, or other disease conditions.
Procedure for Common Extensor Tendon Origin Repair
If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend a surgical procedure called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope – narrow lighted tube with a camera). Your surgeon will decide which option is best for you depending on your specific circumstances.
Surgery will be performed under general anaesthesia. Your surgeon makes a 1 cm incision over the midpoint of the lateral epicondyle to disclose the common extensor tendon origin. In order to protect the radial nerve, the elbow will be flexed. Your surgeon will move aside soft tissues to view the common extensor tendon and its attachment on the lateral epicondyle and then trims or releases the tendon and reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the incision(s) are closed by suturing or by tape.
Common post-operative care guidelines include:
- Elevate the arm above chest level to reduce swelling.
- A brace or splint may be worn keeping the elbow at a 90-degree angle with early motion initiated in the first week.
- Ice packs may be applied to the surgical area to reduce swelling.
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
- Physiotherapy is recommended for strengthening the muscles and to restore normal range of motion.
- Eat a healthy diet and refrain from smoking to promote faster healing.
Risks and Complications of Common Extensor Tendon Origin Repair
As with any major surgery, common extensor tendon origin repair may involve certain risks and complications, such as:
- Allergic reactions to medications
- Blood loss
- Nerve damage
- Radial nerve damage, causing numbness, tingling, burning or loss of feeling in the back of the hand and forearm
- Wrist weakness with extension
- Recurrence or failure of relief from symptoms