Golfer and Tennis Elbow: When Is Surgery Recommended? These common overuse injuries affect millions of active adults each year, causing persistent pain and limiting daily activities. For those seeking immediate answers:
Surgery is typically recommended for tennis or golfer’s elbow only when:
- Conservative treatments have failed after 6-12 months
- Pain significantly impacts daily function and quality of life
- Imaging confirms significant tendon damage or tears
- You’ve tried multiple non-surgical treatments including physical therapy, bracing, and possibly injections
- Your occupation or activities require full elbow function
Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) affect different sides of the elbow but share similar causes – repetitive strain creating micro-tears in the tendons that connect your forearm muscles to the bony prominences of your elbow. These conditions affect 1-3% of the general population annually, with most cases resolving through non-surgical care.
While the names suggest sports origins, these injuries frequently occur in non-athletes through everyday activities like typing, painting, or carrying heavy items. The good news? About 80-90% of people recover successfully without surgery through proper rest, therapy, and medication.
For the 10-20% who don’t respond to conservative care, surgical intervention becomes a consideration – but knowing exactly when that threshold is crossed remains challenging for many patients.
Tennis vs Golfer’s Elbow 101
Ever noticed how elbow pain can strike in different spots? That’s because two distinct conditions often affect this hardworking joint. Understanding the difference is your first step toward proper treatment.
Tennis elbow (lateral epicondylitis) causes pain on the outside of your elbow. This happens when the tendons connecting your forearm extensor muscles to the bony bump on the outside of your elbow (lateral epicondyle) develop tiny tears. You’ll typically feel pain radiating from the outer elbow down your forearm—especially when picking things up, gripping objects, or extending your wrist against resistance.
Golfer’s elbow (medial epicondylitis) is essentially the mirror image, affecting the inner side of your elbow. Here, the tendons of your forearm flexor muscles attached to the medial epicondyle develop similar micro-tears. Pain concentrates on the inside of your elbow and might travel down the inner forearm, particularly when you flex your wrist or grip something tightly.
Both conditions affect about 1-3% of the population annually, with most cases occurring in the dominant arm. Despite their sporty names, these injuries frequently happen to non-athletes through repetitive work activities like typing, painting, or construction tasks.
“These conditions follow a predictable recovery pattern, with about 50% of patients improving every 3-4 months,” explains our orthopedic team at Ventura Orthopedics. “With proper non-surgical care, roughly 90% of patients recover within a year.”
How They Differ & Why It Matters
The key difference between these conditions lies in which muscle groups are affected:
Tennis elbow involves the wrist extensor muscles—those that straighten your wrist and fingers. These muscles work overtime when you hit a tennis backhand or perform activities requiring wrist extension, like using a screwdriver or lifting with your palm facing downward.
Golfer’s elbow affects the wrist flexor muscles—those that bend your wrist and fingers. These engage during a golf swing (particularly at impact and follow-through) or when hammering, throwing, or lifting with your palm facing upward.
These anatomical differences matter tremendously for treatment. The specific bracing techniques differ between conditions, as do the strengthening exercises our physical therapists recommend. Even if surgery eventually becomes necessary, the approach may vary based on which tendons require repair.
Understanding which tendons are involved helps our specialists at Ventura Orthopedics develop precisely targeted treatment plans that address your specific condition rather than taking a one-size-fits-all approach to elbow pain.
Spotting the Problem: Causes, Symptoms & Diagnosis
That nagging elbow pain didn’t appear overnight. Most cases of tennis and golfer’s elbow develop gradually as tiny tears accumulate in your tendons over time. Understanding what’s happening is the first step toward relief.
Most people develop these conditions through everyday activities rather than dramatic injuries. The most common causes include repetitive motions from sports like tennis or golf, but also from work activities like carpentry, painting, or even prolonged computer use. Poor technique or equipment can accelerate the damage, whether it’s an improper tennis backhand or an ergonomically challenged workspace.
“Many patients are surprised to learn their pain comes from activities they’ve done for years without problems,” explains one of our Ventura Orthopedics specialists. “That’s because age-related tendon degeneration, typically between ages 35-55, makes these injuries more likely even if your habits haven’t changed.”
Other contributing factors include inadequate warm-up before activities and occasionally direct trauma to the elbow area.
The symptoms tend to follow a predictable pattern. You’ll typically notice pain that gradually worsens over weeks or months, with tenderness directly over the affected area – outer elbow for tennis elbow, inner elbow for golfer’s elbow. Many patients describe pain radiating down into the forearm, sometimes reaching the wrist.
Daily activities become challenging as you experience weakened grip strength and increased pain when gripping objects. Simple tasks like turning doorknobs, shaking hands, or lifting a coffee mug can become surprisingly difficult. You might also notice stiffness when bending or straightening your arm, and many patients report night aching that disturbs their sleep.
At Ventura Orthopedics, our diagnostic approach is thorough and personalized. We start with a detailed medical history to understand your specific activities, pain patterns, and any treatments you’ve already tried. Our physical examination includes specialized tests like the Cozen test for tennis elbow or resisted wrist flexion for golfer’s elbow.
When necessary, we employ imaging studies to confirm the diagnosis and assess severity:
- X-rays help rule out arthritis or small fractures
- Ultrasound provides a real-time view of tendon damage
- MRI offers detailed images for complex cases or when surgery might be needed
We may also recommend nerve conduction studies if we suspect nerve involvement alongside your tendon issues.
Red Flags That Warrant Early Specialist Visit
While patience is important with elbow conditions, certain symptoms shouldn’t wait. Contact our Ventura Orthopedics team promptly if you experience:
Sudden pop or severe pain that might indicate a tendon rupture. This isn’t the typical gradual onset – you’ll know something significant has happened.
Inability to lift lightweight objects like a coffee mug without significant pain is another concerning sign. When basic daily functions become impossible, it’s time to get help.
Numbness, tingling, or weakness in your hand or fingers could signal nerve involvement beyond simple tendon inflammation. These symptoms require prompt evaluation.
Other red flags include visible deformity or significant swelling, pain that doesn’t improve with rest after 2-3 weeks, or symptoms following direct trauma to your elbow.
As Maria, a 52-year-old teacher from Ventura County, told us: “I thought I just needed to tough it out. By the time I came to Ventura Orthopedics, I couldn’t even grade papers without my hand going numb. Don’t wait as long as I did – early treatment makes all the difference.”
First-Line Care: Conservative Treatments & Timelines
If you’ve been diagnosed with tennis or golfer’s elbow, don’t worry – most people recover without ever needing surgery. At Ventura Orthopedics, we see about 80-90% of patients improve with conservative treatments alone. Your recovery journey typically follows a thoughtful, step-by-step approach:
First, we’ll recommend rest and activity modification to give those irritated tendons a chance to calm down. This doesn’t mean putting your arm in a sling – just temporarily avoiding activities that trigger pain while finding modified ways to stay active.
“My pickleball addiction was clearly making my tennis elbow worse,” shares Martin, a 59-year-old patient. “My doctor at Ventura Orthopedics helped me understand that a six-week break now could prevent months of pain later.”
For pain management, we typically suggest over-the-counter NSAIDs to reduce inflammation, along with ice application for 15-20 minutes several times daily. If you can’t take NSAIDs, acetaminophen can help manage discomfort without addressing the underlying inflammation.
A counterforce brace can be remarkably effective for many patients. These simple straps worn just below the elbow help redistribute forces away from the irritated tendon attachment. Think of it as giving your tendon a little breathing room while it heals.
Physical therapy forms the backbone of effective treatment. Our experienced therapists will guide you through:
- Specialized stretching and strengthening exercises
- Eccentric loading programs that gradually rebuild tendon resilience
- Hands-on techniques to improve tissue mobility
- Proper form instruction to prevent re-injury
For stubborn cases, we may recommend advanced interventions like extracorporeal shock wave therapy or platelet-rich plasma (PRP) injections that harness your body’s natural healing processes. While corticosteroid injections provide quick relief, we use them sparingly as they may weaken tendon tissue over time, especially for golfer’s elbow.
How Long to Persist With Non-Surgical Care
Tendon healing happens on its own schedule – not yours. Understanding typical recovery milestones helps set realistic expectations:
During the first 6 weeks, we focus on calming pain and inflammation while introducing gentle stretching. Don’t expect dramatic improvement yet; tendons heal slowly.
From 6 weeks to 3 months, you’ll progress to more active strengthening exercises. If you’re not seeing meaningful improvement by this point, we might consider PRP or other interventions to jumpstart healing.
The 3 to 6 month period typically brings gradual return to normal activities with continued strengthening. Many patients see significant improvement by this stage.
For persistent cases that reach the 6 to 12 month mark with significant symptoms despite consistent effort, it may be time to have a conversation about surgical options.
“The biological half-life of these conditions means roughly half of patients improve every 3-4 months with proper care,” explains Dr. Thompson at Ventura Orthopedics. “Patience isn’t just a virtue with elbow tendinopathy – it’s essential for recovery.”
Setbacks are normal, especially if you return to aggravating activities too quickly. Our physical therapy team can help you steer these challenges with personalized guidance every step of the way.
Golfer and Tennis Elbow: When Is Surgery Recommended?
Even with the best conservative care, about 10% of tennis or golfer’s elbow patients find themselves considering surgical options. But how do you know when it’s truly time to consider surgery? At Ventura Orthopedics, we don’t rush to surgical solutions – we see them as the final option after a thoughtful journey through non-surgical approaches.
Surgery typically becomes a consideration when persistent pain and dysfunction continue after 6-12 months of comprehensive non-surgical treatment. Most patients who walk through our doors have already tried multiple approaches without finding the relief they need.
“Surgery isn’t about impatience—it’s about recognizing when the tendon damage has exceeded the body’s natural healing capacity,” explains one of our experienced surgeons. “We’re looking for clear indicators that the body needs additional help to heal.”
Those indicators typically include having tried at least two different injection or biologic treatments without success, significant tendon damage confirmed by imaging (MRI or ultrasound), and pain and weakness that substantially limit your daily activities. The impact is often more concerning when the condition affects your dominant arm, interfering with essential functions from writing to cooking.
Decision Checklist Before Saying “Yes” to the Knife
Before recommending surgery, our specialists at Ventura Orthopedics carefully evaluate several key factors that influence both the decision and potential outcomes.
Your occupational demands matter significantly in this decision. If you’re a carpenter, massage therapist, or someone else who relies heavily on arm function for your livelihood, prolonged disability might tip the scales toward earlier intervention when conservative measures aren’t providing adequate relief.
We also closely examine your imaging findings. The extent of tendon degeneration or tearing visible on MRI or ultrasound helps us determine if the tissue can heal naturally or requires surgical repair. Sometimes, what we see explains why conservative approaches haven’t been successful.
Your overall health and any comorbidities like diabetes or rheumatoid arthritis may affect healing potential and surgical outcomes, so we take these into consideration. We also spend time understanding your specific goals and expectations – whether you’re hoping to return to competitive tennis or simply want to lift your grandchild without pain.
Ramon, a 46-year-old patient, recently shared his thought process: “I’ve had tennis elbow pain for years. I’m going to see a physical therapist and look into acupuncture before considering surgery. My doctor at Ventura Orthopedics helped me understand that surgery should be my last resort, not my first option.”
That’s exactly the approach we advocate – thoughtful, patient-centered decision making that explores all options before turning to surgical intervention. When you’ve truly exhausted non-surgical approaches without finding relief, that’s when we should talk about orthopedic elbow surgery as your next step toward recovery.
Surgical Options, Risks & Success Rates
When conservative treatments haven’t provided relief, surgery becomes a consideration. At Ventura Orthopedics, our surgeons bring years of experience with all current techniques, ensuring you receive the approach best suited to your specific condition.
Surgical Approaches
“Think of tendon surgery like gardening,” explains one of our surgeons. “We’re removing the unhealthy tissue and creating the right environment for new, healthy tissue to grow.”
Open Debridement and Repair is the traditional approach we’ve refined over decades. Through a small 1-2 inch incision over your affected epicondyle, we can directly see the damaged tendon, remove diseased tissue, and reattach healthy tendon to bone. We often include gentle bone scraping (decortication) to stimulate healing. This approach gives us excellent visualization but does leave a small scar.
Arthroscopic Release offers a minimally invasive alternative many patients prefer. Using tiny incisions and a specialized camera, we can see your joint and tendon on a monitor while working through small portals. The benefits? Smaller scars and often a quicker initial recovery. This technique shines when other joint issues exist alongside your tendinopathy.
Percutaneous Tenotomy represents one of our least invasive options. Using a needle or small instrument (sometimes guided by ultrasound), we can remove damaged tissue through the smallest possible entry point. The specialized TENEX procedure falls into this category, offering patients a quicker return to daily activities with minimal downtime.
Regardless of approach, we employ various repair techniques based on what we find during surgery: simple removal of damaged tissue, tension-reducing tendon release, reattachment using small anchors if needed, and bone smoothing to create an optimal healing environment.
Good news: all these procedures typically happen on an outpatient basis. You’ll come in the morning and be home the same day, with either regional or general anesthesia keeping you comfortable throughout.
Success Rates and Outcomes
“Will this fix my problem?” It’s the question every patient asks, and rightfully so.
The encouraging answer is that 80-90% of patients experience significant pain relief and improved function following elbow surgery. That’s a strong success rate that gives us confidence when recommending surgical intervention.
Of course, we need to acknowledge the 10-20% of cases where patients may continue to have some symptoms. Sometimes this represents incomplete healing, while other times it may indicate that additional factors were contributing to the pain.
Most patients return to normal activities within 3-6 months following surgery, though your personal timeline depends on factors like your procedure type, overall health, and how diligently you follow rehabilitation protocols. The vast majority return to their previous activity levels, though some high-demand athletes may need to modify their technique to prevent recurrence.
Risks and Complications
As with any surgery, we believe in transparent discussion about potential risks:
Infection is rare (less than 1%) but possible. We take extensive precautions before, during, and after surgery to minimize this risk.
Nerve injury can occur, potentially causing numbness, tingling, or weakness in rare cases. Our surgeons’ intimate knowledge of elbow anatomy helps protect against this complication.
Elbow stiffness sometimes develops during recovery, which is why we start gentle motion exercises relatively early. Our physical therapists are experts at helping patients regain full motion.
Some patients experience persistent pain despite technically successful surgery, which may indicate other contributing factors that need addressing.
Recurrence remains possible, particularly if you return to triggering activities without modifying technique or addressing underlying causes.
Standard surgical risks related to anesthesia, bleeding, and wound healing also apply, though serious complications are uncommon.
Special Situations: Ulnar Nerve & Combined Injuries
Recovery Roadmap and Prevention Tips
The journey after elbow surgery is just as important as the procedure itself. At Ventura Orthopedics, we walk alongside our patients through every step of recovery, ensuring you return to the activities you love with confidence and strength.
Recovery Timeline
Recovery from tennis or golfer’s elbow surgery follows a predictable path, though everyone heals at their own pace. Most patients begin with 1-2 weeks of immobilization in a splint or sling, focusing on wound care and managing discomfort with prescribed medications. During this time, you’ll need to limit use of your affected arm.
By days 3-5, gentle motion begins—marking the start of your active recovery. Your physical therapist will introduce exercises that respect your healing tissues while preventing stiffness. As one patient, Marco, told us: “Those first gentle exercises felt strange but so necessary. My therapist explained how they were preventing the scar tissue from limiting my motion later.”
Between weeks 6-12, you’ll enter an exciting phase where strengthening becomes the focus. Your activities will gradually expand, and you’ll begin working on movements specific to your sport or job. Many patients feel dramatically improved by this stage, though it’s crucial not to rush back to full activity.
Full healing typically takes 3-6 months, with most patients returning to desk work within 1-2 weeks, light manual work by 8 weeks, and heavy labor around the 3-month mark. Patience during this time pays dividends—rushing the process often leads to setbacks.
Sophia, who works as a hairstylist, shared her experience: “I was worried about how long I’d be away from my scissors. My doctor at Ventura Orthopedics helped me set realistic expectations. I returned to modified duties at 3 weeks and was back to full styling by 6 weeks, wearing the supportive strap they recommended during long days.”
Prevention Strategies
Once you’ve recovered, preventing recurrence becomes the priority. Our team at Ventura Orthopedics emphasizes four key areas:
Equipment and workplace adjustments make a tremendous difference. For tennis players, this might mean reassessing racquet grip size or string tension. For office workers, ergonomic keyboards and mouse positioning can prevent undue strain. Even simple changes like using tools with larger, padded grips can protect your healing elbow.
Technique refinement addresses the root cause of many elbow injuries. Whether it’s working with a golf pro to modify your swing or having an occupational therapist assess your workplace movements, proper biomechanics prevent excessive tendon strain.
Regular strengthening and flexibility create resilience in your forearm muscles and tendons. We’ll teach you specific exercises that target the wrist flexors and extensors, along with stretches that maintain tissue mobility. Many patients find that incorporating these into their morning routine provides lasting protection.
Smart activity management means listening to your body’s signals. Warm up thoroughly before activity, take regular breaks during repetitive tasks, and gradually increase intensity when returning to sports or demanding work. As one patient wisely noted, “Five minutes of warming up saves five weeks of healing.”
Frequently Asked Questions about Elbow Surgery
How painful is recovery?
The first few days after surgery typically bring moderate discomfort that gradually improves. Most patients need prescription pain medication for just a short period—usually less than a week—before transitioning to over-the-counter options. Ice application remains your best friend during this time, providing natural pain relief without side effects.
“I was pleasantly surprised,” remembered Richard, a 52-year-old contractor. “The first three days were uncomfortable, especially at night, but by the end of the first week, I was managing with just occasional Tylenol. By week three, I only noticed pain if I accidentally bumped my elbow.”
Will there be visible scarring?
Scarring varies based on your surgical approach. Open surgery typically leaves a 1-2 inch scar along the elbow, while arthroscopic techniques create 2-3 small half-inch scars where the instruments entered. The least invasive percutaneous methods leave minimal scarring.
Our surgeons at Ventura Orthopedics use careful closure techniques to minimize scarring, and most patients find their scars fade significantly within a year. For those concerned about appearance, we can recommend scar management options once healing is complete.
How can I keep the injury from coming back?
Preventing recurrence starts with understanding what caused your initial injury. Was it poor technique in your tennis backhand? Repetitive movements at work? Inadequate equipment? Our team helps identify these factors and develop personalized strategies to address them.
Completing your full rehabilitation program lays the foundation for lasting recovery. The strengthening exercises you learn aren’t just for the recovery period—they should become part of your regular fitness routine. Many patients set calendar reminders to perform their preventive exercises twice weekly.
“The biggest mistake I see,” notes one of our physical therapists, “is patients stopping their exercises once they feel better. The exercises that got you better are the same ones that will keep you better.”
Beyond exercises, listen to your body’s early warning signs. That first twinge of discomfort is your signal to modify activity, check your technique, or take a short break—before small issues become surgical ones.
With proper care and prevention, most patients return to their favorite activities with confidence, often performing better than before their injury due to improved techniques and conditioning.
Call Ventura Orthopedics Today!
At Ventura Orthopedics, we believe in a patient-centered approach that begins with thorough diagnosis and progresses through a comprehensive treatment algorithm before considering surgical intervention. For the majority of patients, non-surgical approaches provide relief and return to function. For those who ultimately require surgery, our experienced team offers the full spectrum of current techniques with excellent outcomes.
With six convenient locations throughout Ventura County—in Ventura, Oxnard, Camarillo, Thousand Oaks, Simi Valley, and Westlake Village—our team at Ventura Orthopedics is ready to help you overcome elbow pain and return to the activities you love, whether that’s golf, tennis, work, or simply pain-free daily living.
If you’re experiencing persistent elbow pain, don’t wait until it significantly impacts your quality of life. Contact Ventura Orthopedics today to begin your journey back to pain-free function.
