When lateral epicondylitis, or tennis elbow, does not respond to conservative treatment, surgery may be indicated in order to relieve the tension off the extensor tendon at the elbow joint.

In an outpatient surgical procedure using an axillary block to numb the arm, an incision is made on the outside of the elbow over the lateral epicondyle. Soft tissues are gently moved aside allowing clear view of the tendons. Degenerative tissue and bone spurs may be removed as the tendons are explored. The extensor tendon is then cut where it connects to the lateral epicondyle and split, allowing any extra scar tissue to be removed. It may be necessary to cut the tendon at its attachment to the bone and remove a small portion of the bone to improve the blood supply to the area.

Rehabilitative exercises begin when sufficient healing of the surgical site is evident.