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Tennis Elbow (Lateral Epicondylitis) Fenestration Procedure

Updated: Jan 19

Rehabilitation Guide

The tendon fenestration procedure is used to treat tennis elbow by creating small, controlled micro-channels in the irritated tendon to stimulate healing. This helps increase blood flow, break down unhealthy tissue, and encourage the tendon to repair itself more effectively. Rehabilitation is essential after the procedure to guide the tendon through a safe, progressive loading plan that supports recovery and helps prevent symptoms from returning.


Following your Fenestration procedure we have created a 12 week guide to help you return to normal function and sport. Please feel free to use this outline in consultation with your own coach or physiotherapist to help you safely return back to your best.


Rehabilitation Exercise Overview

Phase One - Recovery & Early Loading

In this phase, the aim is to settle irritation from the procedure, protect the healing tendon, and gently reintroduce light movements that encourage healthy tissue repair.

Phase Two - Controlled Strengthening

Here we begin structured, gradual strengthening to help the tendon adapt safely to load, improving its tolerance without causing flare-ups.

Phase Three - Heavy Slow Resistance

During this stage, we progressively increase resistance and slow, controlled loading to stimulate stronger tendon remodeling and build long-term resilience.

Phase Four - Functional & Sport Integration

The final phase focuses on restoring full arm function, re-training movement patterns, and preparing you to return to work tasks, hobbies, and sport-specific activities with confidence.



Outcome Measures

  • Strength Symmetry (Isometric Grip Strength)

  • Pain


Phase One - Recovery / Early Loading

In this phase, the aim is to settle irritation from the procedure, protect the healing tendon, and gently reintroduce light movements that encourage healthy tissue repair.


Weeks 1-4


  • Control pain

  • Protect tendon

  • Maintain mobility

  • Pain <3/10




Precautions: avoid repetitive gripping or resisted wrist extension, other than during rehabilitation exercises.


Phase Two - Controlled Strengthening

Here we begin structured, gradual strengthening to help the tendon adapt safely to load, improving its tolerance without causing flare-ups.


Weeks 5-7


  • Restore wrist extensor strength and tendon capacity

  • Progress to eccentrics as pain allows after week 6

  • Pain <2/10


Phase Three - Heavy Slow Resistance

During this stage, we progressively increase resistance and slow, controlled loading to stimulate stronger tendon remodeling and build long-term resilience.


Week 8-10


  • Increase tendon load tolerance

  • Add power / speed

  • Add neural mobility

  • Pain <2/10




Phase Four - Return to ADL's & Sport

The final phase focuses on restoring full arm function, re-training movement patterns, and preparing you to return to work tasks, hobbies, and sport-specific activities with confidence.


Week 10-12


  • Full load tolerance

  • Return to normal activity

  • Integration of sport activity as tolerated





Criteria for discharge:

  • Pain <2/10

  • Symmetrical grip strength (≥90% of contralateral side)

  • Functional performance restored





 
 
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