Pain, swelling, and clicking following tennis elbow surgery
This past week I received a question via my drtomaino.com website from a patient who had tennis elbow surgery several months ago. Her preoperative MRI did not show any ligamentous pathology, and she proceeded with surgical intervention for lateral elbow pain that did not respond to therapy or cortisone. However, she continued to experience not only pain, but clicking--- a feeling of instability--and swelling. An MRI now reveals a synovial fistula and incompetence of the lateral ulnar collateral ligamant (LCL).
Firstly-----these are unusual complications following tennis elbow surgery, and reflect leakage of joint fluid through the capsuloligamentous housing of the joint, and through the extensor musculotendinous layer into the suncutaneous tissue. The clicking/feeling of the joint slipping may reflect posterolateral rotatory instability, which occurs when the LCL is incompetent---either stretched, attenuated, or torn.
Unfortunately these symptoms and signs are not likely to resolve without operative treatment. Treatment will most likely require LCL repair or reconstruction, and extensor closure; rotation of a pedicled anconeous muscle flap may be necessary to afford a durable closure to treat the fistula.