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Epicondilitis lateral (codo de tenista)

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Un programa de rehabilitación basado en la carga para el codo de tenista: primero se controla el dolor y luego se fortalece progresivamente el tendón; abarca tanto el tratamiento no quirúrgico como la recuperación posterior al desbridamiento del tendón ECRB.

Ilustración del exterior del codo, que muestra el tendón extensor común unido al epicóndilo lateral; este es el lugar donde se produce el codo de tenista.
El codo de tenista afecta al tendón extensor común en el punto donde se inserta en la protuberancia ósea situada en la parte externa del codo (el epicóndilo lateral). Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Esta página explica cómo se maneja el codo de tenista y cómo se realiza su rehabilitación, tanto si se trata sin cirugía (que es el caso de casi todos los pacientes) como si se está recuperando tras una operación para reparar el tendón. La supervisa el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton. Comienza con su programa de ejercicios en casa, seguido del protocolo clínico estructurado destinado a su fisioterapeuta o terapeuta de mano; lleve esta página o su versión en PDF a sus sesiones de terapia para garantizar que la rehabilitación se realice de manera coordinada. Su terapeuta podrá ajustar el plan según el progreso de su recuperación.

Qué esperar

El codo de tenista (epicondilitis lateral) es un problema que afecta al tendón situado en la parte externa del codo, concretamente al tendón extensor común y, en particular, a un pequeño músculo llamado ECRB. A pesar del sufijo “-itis” en su nombre, no se trata de una inflamación que pueda resolverse con reposo. En realidad, es un cambio degenerativo del tendón (tendinosis), en el que las fibras tendinosas se han desorganizado y no han sanado adecuadamente.

Esto es importante porque modifica por completo el tratamiento. No mejorará el estado del codo simplemente con reposo y protección; de hecho, el reposo prolongado suele debilitar el tendón y retrasar su recuperación. Para mejorar, es necesario someter el tendón a una carga gradual, de modo que se remodele y recupere su capacidad para soportar esfuerzos y agarres. El proceso consiste en: primero controlar el dolor y luego fortalecer progresivamente el tendón, comenzando con ejercicios isométricos suaves y avanzando hacia ejercicios de fortalecimiento controlados y lentos, como el “Tyler twist”.

La buena noticia es que, con un programa de carga adecuado, el codo de tenista suele mejorar por sí solo. Alrededor de 80–90% de los pacientes experimentan mejoría en el transcurso de un año; aunque en algunos casos puede tardar hasta 12–18 meses en resolverse por completo. La cirugía solo se considera cuando, tras al menos seis meses de rehabilitación constante y de calidad, no se observan mejoras; y solo una pequeña minoría (aproximadamente 4–11%) llega a necesitarla.

Precauciones y limitaciones

Se debe hacer:

  • Seguir utilizando el brazo: cargue el tendón, no lo deje en reposo.
  • Use el dolor como guía: un dolor leve durante y después del ejercicio es normal y esperado; un dolor agudo o en aumento indica que debe reducir la intensidad.
  • Levante los objetos con la palma hacia arriba (como si sostuviera un tazón de sopa) para reducir la carga sobre el tendón dolorido.
  • Utilice un aparato de contrafuerza sobre el músculo del antebrazo durante tareas de agarre y levantamiento.

No se debe hacer:

  • No inmovilice el codo con un yeso o cabestrillo en caso de codo de tenista; ese no es el tratamiento adecuado para una tendinosis.
  • No realice agarres intensos con el codo extendido y la muñeca flexionada (por ejemplo, levantar un objeto pesado con la palma hacia abajo).
  • No recurra de inmediato a una inyección de esteroides. La cortisona puede aliviar los síntomas durante unas pocas semanas, pero la evidencia demuestra que a los 6–12 meses produce peores resultados y más recurrencias que la fisioterapia o simplemente esperar. No es un tratamiento de primera línea.

Sus ejercicios

Estos son los ejercicios que aparecen en su folleto. Siguen el proceso de recuperación en orden: el corsé de contrafuerza y las contracciones isométricas ayudan a controlar el dolor al principio; los estiramientos mantienen la flexibilidad del antebrazo; y el giro de Tyler, la rotación del antebrazo y los ejercicios de agarre ayudan a fortalecer nuevamente los tendones. Comience a realizarlos según las indicaciones del Dr. Hirpara y su terapeuta; no es necesario hacerlos todos desde el primer día. Su terapeuta le indicará cuáles debe iniciar y cuándo añadir los ejercicios de fortalecimiento.

Su protocolo clínico

El resto de esta página contiene el protocolo de rehabilitación clínica para la epicondilitis lateral (codo de tenista). Esta sección debe entregarse a su fisioterapeuta o terapeuta de la mano; cada fase comienza con una explicación sencilla en lenguaje coloquial sobre lo que está ocurriendo.

El protocolo consta de dos vías: una vía no quirúrgica (tratamiento de primera línea para prácticamente todos los pacientes) y una vía postoperatoria destinada a aquellos pocos pacientes que se someten a desbridamiento del tendón extensor radial corto del carpo tras haber recibido tratamiento conservador de calidad durante seis meses o más sin obtener resultados.

Vía no quirúrgica

El principio fundamental es la carga progresiva del tendón, guiada por el nivel de dolor. El objetivo es acortar la duración de los síntomas y restaurar la tolerancia a la carga, no mantener el tendón en reposo.

Fase I — Control agudo del dolor (0–2 semanas)

El objetivo aquí es controlar el dolor y restablecer el movimiento sin carga. No se practica inmovilización; se trata de un reposo relativo, no de un vendaje rígido.

Para su fisioterapeuta:

  • Objetivos: controlar el dolor; restablecer el rango de movimiento activo completo sin carga (AROM).
  • Manejo: modificación de actividades, protección articular y consejos ergonómicos. Opcionalmente, se puede utilizar un tutúr de contrapeso sobre la masa extensora común para disminuir la carga sobre el origen del ECRB durante la prensión; también se puede emplear una férula de muñeca (en posición de extensión) si existe dolor agudo al realizar movimientos de extensión. Para controlar el dolor: hielo, movilización de tejidos blandos mediante técnicas manuales o instrumentales (IASTM), AROM suave y sin dolor; también se puede considerar la acupuntura seca y los deslizamientos nerviosos.
  • Criterios para avanzar: AROM completo sin dolor y capacidad para realizar de forma independiente el programa de ejercicios en casa.

Fase II — Subaguda / carga temprana (2–4 semanas)

Se inicia la carga tendinosa de forma gradual, y se trabaja la cadena cinética proximal (omóplato y manguito rotador), ya que la debilidad en la parte superior del brazo provoca sobrecarga en el codo.

Para su fisioterapeuta:

  • Objetivos: iniciar la carga tendinosa; trabajar la cadena cinética proximal.
  • Ejercicios: carga isométrica de los extensores y flexores de la muñeca (carga ligera; los ejercicios isométricos se toleran bien y tienen efecto analgésico en la tendinopatía reactiva); estiramientos progresivos de los flexores y extensores de la muñeca con el codo a 90°; ejercicios proximales: serrato anterior, trapecio medio/inferior, manguito rotador y estabilizadores del omóplato.
  • Criterios para avanzar: se mantiene la amplitud de movimiento completa; el paciente tolera el estiramiento con el codo flexionado a 90°; se alcanza aproximadamente el 70 % de la fuerza/agarre del lado contralateral.

Fase III — Fortalecimiento / retorno (4–6+ semanas; a menudo hasta 12 semanas)

En esta fase se reconstruye el tendón y se restaura la tolerancia a la carga para el trabajo y el deporte. La carga excéntrica-concéntrica constituye el pilar terapéutico principal.

Para su fisioterapeuta:

  • Objetivos: restaurar la tolerancia a la carga y la capacidad para el deporte y el trabajo.
  • Ejercicios: carga excéntrica-concéntrica de extensión de muñeca y pronación/supinación del antebrazo; el Tyler Twist (FlexBar) es el instrumento excéntrico típico para uso en casa. Se debe progresar hacia el estiramiento con el codo extendido; además, utilizar la movilización con movimiento (Mulligan). También se recomienda el fortalecimiento de la prensión y la carga específica para tareas o deportes; para atletas, se pueden emplear ejercicios pliométricos. Se debe retirar gradualmente el soporte de contrafuerza a medida que el paciente quede asintomático. Para atletas, es necesario modificar el equipamiento (tamaño de la empuñadura, tensión de las cuerdas, técnica).
  • Criterios para avanzar (retorno al deporte): aproximadamente el 90 % de la fuerza del lado contralateral, función sin dolor y capacidad de autogestión.

Protocolo postoperatorio (desbridamiento del ECRB ± liberación)

La cirugía está indicada únicamente para aquellos pacientes (~4–11%) que no responden a al menos 6 meses de tratamiento conservador adecuado. El desbridamiento abierto de tipo Nirschl y el desbridamiento artroscópico del ECRB arrojan resultados similares. El cronograma que se detalla a continuación sigue el Estándar de Atención de Brigham & Women’s para el desbridamiento del epicóndilo lateral.

Fase 1 — Protección (Días 1–7)

Durante la primera semana, el cabestrillo se utiliza únicamente para mayor comodidad.

Para su fisioterapeuta:

  • El cabestrillo sirve solo para comodidad; aplicar hielo durante 20 minutos, 2–3 veces al día; usar una almohadilla en el codo sobre la incisión.
  • Realizar movimientos activos de amplitud de rango de movimiento en la mano, muñeca y codo, siempre sin dolor; ejercicios de movilidad del hombro; ejercicios periescapulares.
  • Evitar al máximo las actividades de la vida diaria que sobrecarguen el mecanismo extensor (levantar objetos, extender completamente el codo combinado con flexión de muñeca); levantar objetos con la palma hacia arriba para reducir la carga sobre los extensores; si el dolor es intenso, se puede usar una férula de muñeca de forma opcional.

Fase 2 — Movilización temprana (Semanas 2–4)

Para su fisioterapeuta:

  • Retire el cabestrillo. Comience con movilización pasiva y asistida dentro de los límites del dolor tolerable.
  • Fortalecimiento suave: movimientos activos e isometría submáxima. Inicie el cuidado de la cicatriz.

Fase 3 — Fortalecimiento (Semanas 5–7)

Para su fisioterapeuta:

  • Progresar con el fortalecimiento resistivo (pesas / bandas elásticas Theraband), enfocándose en la resistencia de los extensores de la muñeca (carga ligera, mayor número de repeticiones). Restaurar el rango de movimiento activo y pasivo por completo.
  • Introducir ortesis de contrafuerza para el tendón extensor común (acompañadas de instrucciones para evitar la compresión nerviosa); realizar un masaje transversal suave; comenzar la preparación funcional.

Fase 4 — Funcional / retorno a la actividad (Semanas 8–12)

Para su fisioterapeuta:

  • Entrenamiento funcional orientado a tareas específicas; retorno a actividades laborales de mayor exigencia y a actividades recreativas.
  • Continuar utilizando el dispositivo de contrafuerza según sea necesario para realizar actividades de la vida diaria sin dolor y para el fortalecimiento muscular.

Volver al trabajo y a las actividades

Si está tratando el codo de tenista sin cirugía, no existe un período fijo de “inactividad laboral”; puede seguir utilizando el brazo, modificando las tareas que requieran mayor fuerza de agarre y levantamiento, y empleando un soporte contrarresistente para afrontarlas. Lo razonable es esperar que el codo mejore en el transcurso de 6–12 meses; la mayoría de las personas (80–90%) experimentan una mejoría dentro de un año. Se trata de un problema tendinoso de evolución lenta, por lo que los avances se miden a lo largo de semanas y meses, no de días. Mantenerse fiel al programa de carga es lo que permite lograr esa mejoría; los brotes de dolor ocasionales son normales y no representan un retroceso, siempre y cuando el malestar leve desaparezca al día siguiente.

En caso de haberse sometido a cirugía, el cabestrillo se usa únicamente para mayor comodidad durante la primera semana y se retira a medida que el codo se estabiliza. El fortalecimiento comienza a notarse a partir de la semana 5–7; la mayoría de los pacientes vuelven a desempeñar sus actividades laborales y recreativas alrededor de la semana 8–12. Las exigencias más intensas y específicas del deporte se reintroducen gradualmente en ese periodo, según la tolerancia del tendón a la carga.

El regreso al deporte (en ambos casos) depende de alcanzar aproximadamente el 90 % de la fuerza del otro brazo, además de contar con una función sin dolor y la confianza para autogestionarse; no se basa únicamente en el paso del tiempo.

Después de seguir este protocolo

Este protocolo complementa las recomendaciones generales de recuperación que ofrece la clínica; consulte cómo manejar el dolor postoperatorio y, si se ha sometido a cirugía, cuidados de la herida y conceptos básicos de la terapia de la mano. El plan por fases descrito anteriormente se basa en las mejores evidencias actuales para el codo de tenista (carga progresiva del tendón en lugar de reposo); su recuperación continua será guiada individualmente por su fisioterapeuta o terapeuta de la mano, según la evolución de su codo.

Reviewed by Dr Kieran Hirpara · 18 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Lateral Epicondylitis (Tennis Elbow) — Non-operative & Post-operative Rehabilitation

Topic scope: (A) the natural history and stepped non-operative management of lateral epicondylitis (relative rest → progressive tendon loading: isometric → eccentric–concentric; counterforce bracing; controversies around corticosteroid and PRP injection), and (B) post-operative rehabilitation after open or arthroscopic ECRB debridement ± release, reserved for the minority who fail ≥6 months of quality conservative care.

Defining principle: despite the "-itis" suffix, lateral epicondylitis is a degenerative tendinopathy (tendinosis) of the extensor carpi radialis brevis (ECRB) origin, not an inflammatory condition. This reframes treatment away from rest and anti-inflammatory measures and toward progressive tendon loading — settle pain with isometrics, then rebuild load tolerance with eccentric–concentric loading (the Tyler twist / FlexBar). KH's stance: load the tendon, do not immobilise it; corticosteroid injection is avoided as first line because it is better short-term but worse at 6–12 months; surgery is a last resort after ≥6 months of genuine conservative care.

A. NATURAL HISTORY & NON-OPERATIVE MANAGEMENT

Natural history (self-limiting in most)

Lateral epicondylitis is self-limiting in the majority: roughly 80–90% resolve within about one year regardless of treatment, with the conservative literature ranging out to 12–18 months [Coonrad & Hooper 1973; Nirschl 1999]. This high spontaneous-resolution rate is the central methodological challenge of the field — any intervention must beat natural history, a high bar most fail to clear. The goal of therapy is therefore to shorten the symptomatic course and restore load tolerance, not to "cure" a condition that largely settles on its own.

Phased non-operative rehabilitation

First-line for essentially all comers. The therapeutic core is progressive tendon loading guided by pain.

Phase I — Acute / pain control (~0–2 weeks). Relative rest, NOT immobilisation — avoid full wrist/elbow casting (Nirschl). Activity modification, joint protection, ergonomics. Optional counterforce brace over the common extensor mass (offloads the ECRB origin during grip) ± a wrist cock-up splint if acutely painful. Adjuncts: ice, soft-tissue/IASTM, pain-free AROM, optional dry needling, nerve glides. Criterion to progress: full unloaded AROM without pain; independent with home program. Consensus / institutional protocol.

Phase II — Sub-acute / early loading (~2–4 weeks). Begin isometric wrist flexor/extensor loading (minimal load; isometrics are well tolerated and analgesic in reactive tendinopathy). Progressive stretching of wrist flexors/extensors with the elbow at 90°. Add proximal kinetic-chain work (serratus anterior, mid/lower trapezius, rotator cuff, scapular stabilisers — proximal deficits drive distal overload). Criteria to progress: full ROM maintained; tolerates stretch at 90° elbow flexion; ~70% contralateral grip/strength. Moderate (strengthening trials) / Consensus (timeline).

Phase III — Late / strengthening & return (~4–6+ weeks, often to 12 weeks). Eccentric–concentric loading of wrist extension and forearm pronation/supination is the core driver; the Tyler twist (FlexBar eccentric wrist-extension) is the prototypical home tool. Progress stretching to the elbow-extended position; add mobilisation-with-movement (Mulligan). Grip strengthening and task-/sport-specific loading; plyometrics for athletes. Gradually wean the counterforce brace as the patient becomes asymptomatic. Return-to-sport criteria: ~90% contralateral strength, pain-free function, self-management competence. Moderate–High (RCT/SR for exercise & loading) / Consensus (phase timings).

B. POST-OPERATIVE REHABILITATION (open or arthroscopic ECRB debridement ± release/repair)

Surgery is reserved for the ~4–11% who fail ≥6 months (commonly 6–12 months) of quality conservative care. Open Nirschl-type debridement and arthroscopic ECRB debridement give comparable complication and reoperation rates (national database, Arthroscopy 2022); arthroscopy additionally allows intra-articular inspection. The phased timeline below is the Brigham & Women's Standard of Care for lateral epicondyle debridement, cross-checked against community ECRB-release protocols.

Phase Window Sling / support Motion & strengthening Notes
1 — Protect Days 1–7 Sling for comfort; optional wrist splint if painful Pain-free hand/wrist/elbow AROM; active shoulder ROM; periscapular work Ice 20 min 2–3×/day; elbow pad over incision; lift palm-up to offload extensors
2 — Early motion Weeks 2–4 Discontinue sling PROM + active-assisted motion within pain tolerance; sub-maximal isometrics Begin scar management
3 — Strengthening Weeks 5–7 Introduce counterforce brace Advance resistive strengthening (weights/Theraband); wrist-extensor endurance (light load, high rep); restore full A/PROM Education to avoid nerve compression; cross-fibre massage
4 — Functional / return Weeks 8–12 Counterforce brace as needed Task-specific functional training; return to work/recreation Functional return wk 8–12

Alternative published timelines (community ECRB-release protocols): wrist splint full-time 0–2 wk with no strengthening; full ROM goal by 4–6 wk; strengthening + transition to counterforce brace

6 wk; full activity ~8–10+ wk. Note: one comparative series found post-op bracing/immobilisation delayed symptom resolution versus PRP (mean time to full ROM 96 days surgery vs 42 days PRP) — reinforcing that early controlled motion, not protection, is the goal.

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Corticosteroid injection: better short-term, WORSE long-term. The Bisset/Smidt body of work (and the BMJ 2006 mobilisation-with-movement RCT) shows steroid gives early relief but higher recurrence and worse 6–12-month outcomes than physiotherapy or wait-and-see. Some authors now call it "always inadvisable" for lateral elbow (Orthop Trauma Surg Res 2019). Prior injection is associated with eventual surgery (a proxy for severity). Strong (Level-1 RCT).
  2. PRP / autologous blood: contested. Some Level-1 RCTs (Peerbooms 2010; Gosens 2-yr) show PRP superior to corticosteroid with ongoing 2-year benefit; others (Krogh 2013) found PRP ≈ glucocorticoid ≈ saline (no benefit over placebo). Meta-analyses are heterogeneous. Net: a reasonable second-line for refractory cases, but evidence is inconsistent. Conflicting (Level-1).
  3. Eccentric vs concentric vs isometric. Pure eccentric (Alfredson-style) is effective but not clearly superior; current view favours eccentric–concentric combined loading, with isometrics for early analgesia. Grip/isometric demands of the elbow differ from the Achilles, so blanket extrapolation of eccentric-only protocols is questioned. Moderate.
  4. Surgical indication/timing & technique. Reserve for failure of ≥6 months conservative care. Open vs arthroscopic debridement: no significant difference in complication or reoperation rates (national database, Arthroscopy 2022); choice is surgeon-/training-dependent. Repair after debridement vs debridement alone remains unsettled. Surgical incidence is declining, attributed to eccentric-exercise protocols and injections. Moderate.
  5. Self-limiting nature complicates all evidence: ~80–90% resolve within a year regardless of treatment, so any intervention must beat natural history. Strong (natural-history signal).

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE–HIGH (RCT / SR): progressive loading (eccentric / eccentric–concentric) and exercise therapy for non-operative lateral epicondylitis; mobilisation-with-movement (BMJ 2006); the natural-history signal (~80–90% resolve within ~1 year).
  • MODERATE (cohorts / database): post-operative ECRB debridement outcomes; equivalence of open vs arthroscopic debridement (no difference in complication/reoperation rates).
  • CONSENSUS / institutional (Level-5): the phase timelines themselves derive from Standard-of-Care protocols (Brigham & Women's, Mass General Brigham, Campbell's/Nirschl) — broadly concordant across sources but not trial-derived.
  • STRONG (against, Level-1): corticosteroid injection as first-line — better short-term, worse at 6–12 months.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Bisset L et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006. DOI: 10.1136/bmj.38961.584653.AE
  • Krogh TP et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013. DOI: 10.1177/0363546512472975
  • Peerbooms JC et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial. Am J Sports Med. 2010. DOI: 10.1177/0363546509355445
  • Gosens T et al. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011. DOI: 10.1177/0363546510397173
  • Ortega-Castillo M, Medina-Porqueres I. Effectiveness of the eccentric exercise therapy in physically active adults with symptomatic shoulder impingement or lateral epicondylar tendinopathy: a systematic review. J Sci Med Sport. 2016. DOI: 10.1016/j.jsams.2015.05.010
  • Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003. (Current Concepts — Tendinosis of the Elbow, J Bone Joint Surg Am. 1999. DOI: 10.2106/00004623-199902000-00016)
  • Coonrad RW, Hooper WR. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am. 1973. DOI: 10.2106/00004623-197355060-00002
  • Lattermann C et al. Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg. 2010. DOI: 10.1016/j.jse.2010.02.008

Lateral epicondylitis literature (URLs)

  • Comparative efficacy and safety of nonsurgical treatment options for enthesopathy of the ECRB: a systematic review and meta-analysis of randomized trials. Am J Sports Med. 2018. https://pubmed.ncbi.nlm.nih.gov/29268037/
  • Eccentric, eccentric–concentric, and eccentric–concentric + isometric training in lateral elbow tendinopathy. J Hand Ther. 2017. https://pubmed.ncbi.nlm.nih.gov/28732560/
  • Role of strengthening during nonoperative treatment of lateral epicondyle tendinopathy. J Hand Ther. 2021. https://pubmed.ncbi.nlm.nih.gov/33041157/
  • Chronic lateral elbow tendinopathy managed with a supervised graded exercise protocol. J Hand Ther. 2023. https://pubmed.ncbi.nlm.nih.gov/36127241/
  • Management of lateral epicondylitis. Orthop Traumatol Surg Res. 2019. https://pubmed.ncbi.nlm.nih.gov/30414784/
  • No difference in complication or reoperation rates between arthroscopic and open debridement for lateral epicondylitis: a national database study. Arthroscopy. 2022. https://pubmed.ncbi.nlm.nih.gov/34838651/
  • Wang D et al. Trends in surgical practices for lateral epicondylitis among newly trained orthopaedic surgeons. Orthop J Sports Med. 2017. https://pubmed.ncbi.nlm.nih.gov/28840148/
  • Factors associated with failure of nonoperative treatment in lateral epicondylitis. Am J Sports Med. 2015. https://pubmed.ncbi.nlm.nih.gov/26015443/

Published rehab protocols (patient-guidance — basis for the phase structure)

  • Brigham & Women's Hospital — Post-Op Protocol for Lateral Epicondyle Debridement. https://www.brighamandwomens.org/assets/bwh/patients-and-families/rehabilitation-services/pdfs/elbow-lateral-epicondyle-debridement-postoperative-bwh.pdf
  • Mass General Brigham Sports Medicine — Rehabilitation Protocol for Medial/Lateral Epicondylitis (non-operative), rev. April 2021. https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-medial-lateral-epicondylitis.pdf
  • Beacon Orthopaedics — Lateral Epicondylitis ECRB Surgical Release Protocol. https://www.beaconortho.com/wp-content/uploads/Lateral-Epicondylitis-Release.pdf

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.