If the patient does not respond to conservative treatment, surgery is considered when:
- Large tears in the tendon or other extreme damage to the elbow is the result of a sudden (acute) injury.
- The injury is the direct result of chronic overuse, and after six to twelve months of rehabilitation and tendon rest hasn’t relieved elbow pain.
- Elbow pain continues despite other treatments, such as acupuncture or corticosteroid shots.
- Loss of internal rotation of the shoulder has not responded to stretching exercises
- Shoulder pain has not responded to stretching and strengthening exercises, rest, or injections of cortisone
- MRI reveals labral or rotator cuff tears
The type of surgery performed depends on the pathology. However, commonly performed procedures in the throwing elbow include medial collateral ligament reconstruction (Tommy John procedure) and arthroscopic debridement. Commonly performed shoulder procedures include arthroscopic posterior capsular contracture release, labral repair, and rotator cuff repair.
Complete recovery of surgery varies with each patient and with the pathology encountered. Most individuals are capable of returning to their daily routine within a period of approximately three to six weeks. It is important to warn the patient that the initial relief from arm pain does not allow them to engage in heavy activity or sports for at least four or more months. Return to throwing competition can require 12-15 months. Tendons take a long time to heal completely. Subjecting the tendons to strong forces may cause significant delay in healing or cause permanent damage, or cause significant damage.
