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Tennis elbow (lateral epicondylitis) — causes, symptoms, and conservative treatment options for pain relief.

Updated Aug 20261 citations
A hand-drawn illustration of a faceless person playing a tennis backhand.
Tennis elbow: irritation where the forearm tendons attach to the outer elbow. Kieran Hirpara 4.0

What you're feeling

You likely feel a dull ache or sharp pain on the outside of your elbow. This area is called the lateral epicondyle. The discomfort often starts near the bony bump on the outside of your elbow and may travel down your forearm toward your wrist. You might notice the pain feels stiff when you first wake up in the morning. It can also flare up after you have been using your arm for a while.

Certain movements make the pain worse. You may feel a twinge when you lift a coffee mug. Gripping objects firmly, like a tennis racket or a vacuum cleaner, can trigger sharp pain. Turning a doorknob or shaking hands might also cause discomfort. Even holding a heavy grocery bag can strain the tender area. You might find yourself avoiding these tasks to protect your arm.

The good news is that this condition often improves on its own. Tennis elbow is a self-limiting problem, meaning it tends to resolve without aggressive intervention. Most people see significant relief within six months, regardless of the treatment used. About 90% of individuals experience symptom resolution by one year. This recovery rate remains steady even if you have had symptoms for a long time. Your symptoms have a steady half-life of three to four months. This means the pain gradually fades over time.

While your surgeon will examine your elbow to confirm the diagnosis, rest and gentle activity are often the first steps. Persistent symptoms are not a strong reason to rush into surgery. Most patients recover without it. For the small percentage who do not respond to non-surgical care, surgical options provide near 90% satisfaction rates. However, for now, focus on managing daily tasks gently. Avoid heavy lifting or repetitive gripping when possible. Listen to your body and allow the natural healing process to take its course.

What's actually happening

Tennis elbow is a wear-and-tear injury to the tendons on the outside of your elbow. These tendons connect your forearm muscles to the bony bump on your elbow. They act like ropes that help you extend your wrist and fingers. Over time, repetitive gripping or lifting causes tiny tears in these tendon fibers. Your body tries to repair them, but the constant stress prevents full healing. This leads to inflammation and pain.

The pain often feels sharp when you lift objects or shake hands. This happens because the damaged tendon is under tension. When you extend your elbow and turn your palm down, the pressure between the bone and tendon increases significantly. It is like a frayed rope being pulled tight against a rough surface. The area becomes sensitive to touch and movement.

Your body’s natural healing process is slow. Symptoms of tennis elbow have a steady half-life of three to four months. This means it takes that long for the pain to reduce by half, even without treatment. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year. The probability of recovery remains fairly constant over a one-year timespan, regardless of how long you have had symptoms. Longer symptom duration does not indicate a poorer prognosis without surgery.

Most cases resolve with appropriate nonoperative treatment protocols. However, for the small percentage of patients who do not respond to these approaches, surgery provides near 90% satisfaction rates. Surgical interventions may be performed with a high rate of success when conservative methods fail. Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it.

We focus on the upper segments of your body, including your shoulder position and muscle strength, to manage this condition effectively. Physical examination is a critical component in formulating an accurate diagnosis. We also use counterforce bracing to reduce pain frequency and severity in the short term (2-12 weeks). This bracing improves overall elbow function at 26 weeks compared with a placebo brace. By addressing the root cause and supporting your healing, we help you return to normal activities.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Most cases of tennis elbow resolve by 6 months in most cases regardless of the treatment used. We begin with simple self-care and physiotherapy. You can manage pain with rest and activity modification. Avoid movements that strain the outer elbow. A physiotherapist will guide you through exercises to strengthen the forearm muscles. This approach helps most patients feel well-managed without needing further intervention.

If pain persists, we discuss medical management. This includes pain medication and anti-inflammatory drugs to reduce swelling and discomfort. We may also offer injections. Cortisone injections can provide short-term relief, but they do not offer long-term clinical benefit compared to observation alone. Platelet-rich plasma or autologous blood injections do not reduce pain or improve function in patients with lateral elbow tendinopathy. We focus on treatments that provide small pain relief while minimizing adverse events. You should give any non-surgical treatment a fair trial before considering more invasive steps.

Surgery is considered only when conservative care has not given enough improvement after several months. We reserve surgical options for refractory cases where daily life remains difficult. Procedures such as arthroscopic release or open lateral release aim to remove damaged tissue and relieve pressure on the tendon. These techniques allow for a marked postoperative increase in function within a short rehabilitation period. We discuss the risks and benefits with you to ensure it is the right choice for your specific situation.

What to expect

Your outlook for tennis elbow is generally positive. This condition often resolves on its own over time. About 90% of people see their symptoms disappear within one year, even without specific treatment. Most cases settle within six months, regardless of the care you receive. The chance of recovery stays fairly steady over time. How long you have had pain does not change this likelihood.

Symptoms tend to fade gradually. You might notice a steady improvement every three to four months. About three out of four people with recent symptoms recover within a year. Because most people get better without surgery, persistent pain is usually not a strong reason to choose an operation. Your surgeon cannot reliably predict who will improve with non-surgical care and who will not.

If you try non-surgical treatments and they do not help, surgery is an option. For the small number of patients who do not respond to other approaches, surgery provides near 90% satisfaction rates. Surgical interventions for tennis elbow are considered discretionary. They should be chosen only if they offer better results than waiting or placebo treatments.

We focus on managing your pain and function through a step-by-step approach. We believe in giving your body time to heal naturally first. If you need further intervention, we discuss all options clearly. Our goal is to help you return to your daily activities with less pain. We do not promise a specific outcome, but we provide evidence-based care to support your recovery.

When to see someone

See your GP if pain persists despite rest. Tennis elbow often resolves by 6 months in most cases, or by 1 year in about 90% of people. However, seek specialist review if you experience weakness, instability, or locking. Symptoms interfering with sleep or work also warrant assessment. Your surgeon will examine your elbow to confirm the diagnosis. This physical check is critical for accuracy. About half of patients with lateral elbow pain have a different condition. Early evaluation helps rule out other causes. If conservative care fails, your surgeon may discuss further options. The risk of needing revision surgery is low at 1.5%. Most open techniques offer long-term results with few complications.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Tennis elbow is worth the extra reading because it is one of the conditions where the treatment that feels most effective in the first month is the one that does worst by the end of the year.

The condition mostly cures itself, slowly

Left alone, tennis elbow settles. In the trial discussed below, the group randomised to simply wait and see — no injection, no physiotherapy — was reassessed at 52 weeks, and 56 of 62 (90%) reported themselves either much improved or completely recovered [1].

That figure is the yardstick every treatment has to be measured against. An intervention is only worth having if it beats getting better on your own, and getting better on your own is what usually happens.

The corticosteroid paradox

A landmark randomised trial compared corticosteroid injection, physiotherapy, and simply waiting, following people for a full year [1].

At six weeks the injection looked excellent. Success was reported by 51 of 65 (78%) of the injection group against 16 of 60 (27%) of those waiting — a number needed to treat of 2 [1].

Then it reversed. Of those early successes, 47 of 65 (72%) subsequently regressed. By 52 weeks the injection group was significantly worse than the physiotherapy group on every outcome, and worse than the people who did nothing on two of the three primary measures [1].

The authors' own explanation is worth repeating: the injection relieves pain so quickly that people resume loading a tendon that has not actually healed. The trial's conclusion was that corticosteroid "should be used with caution" in tennis elbow — a striking thing to say about the treatment most people expect to be offered.

This is why an injection here is a considered decision about short-term function, not a default, and why it is not a substitute for the loading programme.

So what is worth doing

Physiotherapy beat waiting at six weeks on every measure, and by 52 weeks the two were indistinguishable because nearly everyone in both groups had recovered [1]. Its value is therefore in getting you through the painful months faster, not in changing the destination. Notably, the physiotherapy group also sought less additional treatment along the way [1]. Given that, the sensible plan is load management and a progressive tendon programme, accepting that the timeline is measured in months.

Surgery is reserved for the small minority still disabled after a genuine and prolonged trial of non-operative care. The reason that threshold is set high is precisely the natural history above: operate early and you are competing against a condition that was, in nine cases out of ten, going to resolve anyway.

Reviewed by Dr Kieran Hirpara · 7 August 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.

References
  1. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
Evidence & references

Overview

  • There is no true consensus on the most efficacious management of tennis elbow, especially regarding effective long-term outcomes [1].
  • Tennis elbow is a common problem that resolves by 6 months in most cases regardless of the treatment used [2].
  • For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates [2].
  • Corticosteroid injections for tennis elbow worsen the long-term outcomes of patients [4].
  • Symptoms of tennis elbow have a steady half-life of three to four months [5].
  • Longer symptom duration does not indicate a poorer prognosis without surgery [5].
  • Failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [5].
  • Persistent tennis elbow symptoms are a poor indication for surgery because the majority of patients experience symptom resolution without it [6].
  • Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment [6].
  • Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year [8].
  • The probability of recovery remained fairly constant over that timespan regardless of prior symptom duration [8].
  • The concept that surgery is indicated if symptoms persist for an arbitrary duration is undermined by evidence showing constant recovery probability [8].
  • Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations [27].
  • Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols [22].
  • When nonoperative treatment is unsuccessful, surgical interventions may be performed with a high rate of success [22].
  • The Boyd–McLeod procedure is an excellent option over both the short- and long-term for refractory tennis elbow [40].

Anatomy & Pathophysiology

  • Combined physical exertion and elbow movements are strongly associated with lateral epicondylitis [9].
  • Physical examination is a critical component in formulating an accurate diagnosis of elbow conditions [10].
  • Evaluation and management of elbow injuries in young athletes requires knowledge of immature developing anatomy and injury pathophysiology [20].
  • Elite tennis players exhibit a low carrying angle just before ball impact during the forehand, suggesting dynamic varus instant accommodation moving towards full extension [24].
  • The observed decrease in carrying angle in elite tennis players is a consequence of an increase in elbow flexion position dictated by the transition from closed to open, semi-open stances [24].
  • Pre-operative evaluations for elbow stiffness should identify involved articular and periarticular tissues and determine whether articular surfaces and osteoarticular congruence are preserved [26].
  • Further understanding of the static and dynamic anatomy of the lateral part of the elbow is necessary to develop future treatment and preventive strategies for persistent lateral elbow pain from posterolateral impingement [31].
  • Musculoskeletal ultrasonography provides a dynamic, functional assessment of elbow structures, allowing visualization of pathology under stress and motion [32].
  • Understanding anatomy and biomechanics allows for the reconstruction of chronically dislocated joints to achieve functional and painless elbows [33].
  • Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state [38].
  • The spin move is a simple maneuver that can improve exposure of the coronoid process regardless of the degree of elbow instability [43].
  • An internal joint stabilizer with a standardized treatment protocol could maintain concentric reduction while allowing early functional motion and improve clinical outcomes for patients with complex persistent elbow instability [46].
  • Understanding the patterns of traumatic elbow instability helps surgeons counsel and manage patients with these injuries [53].
  • Elbow arthroscopy has become a safer and more effective treatment modality for several elbow pathologies due to advances in equipment and surgical technique [55].
  • The greatest shoulder and elbow peak forces occurred in pitchers with 15° to 25° contralateral trunk tilt (three-quarter arm slot) [56].
  • Restoration of osseous anatomy, particularly the coronoid, is a priority in restoring elbow alignment and maintaining ulnohumeral joint stability in postoperative elbow instability [57].
  • Arthroscopic tennis elbow release involves placing the patient prone with the ipsilateral shoulder abducted to 90 degrees and supporting the arm with a precut foam holder [59].
  • Joint distension for arthroscopic tennis elbow release is performed with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [59].
  • The proximal medial or superomedial portal for arthroscopic tennis elbow release is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [59].
  • The trocar for the proximal medial or superomedial portal is introduced anterior to the intermuscular septum, maintaining contact with the anterior aspect of the humerus as it is directed toward the radial head [59].
  • A 2.7-mm, 30-degree arthroscope is used to perform the diagnostic portion of arthroscopic tennis elbow release [59].
  • The superolateral portal for arthroscopic tennis elbow release is established with an 18-gauge needle through the lesion [59].
  • A full-radius resector is used to excise the capsule to identify the undersurface of the extensor carpi radialis brevis tendon during arthroscopic tennis elbow release [59].
  • The origin of the extensor carpi radialis brevis is viewed during arthroscopic tennis elbow release [59].
  • A curet and motorized shaver are used to debride the capsule and the pathologic tendinous attachment of the extensor carpi radialis brevis and decorticate the lateral epicondyle during arthroscopic tennis elbow release [59].
  • Decortication of the lateral epicondyle and lateral epicondylar ridge can be done with an arthroscopic burr, handheld instruments, or electrocautery during arthroscopic tennis elbow release [59].
  • A 70-degree arthroscope may be required in rare instances during arthroscopic tennis elbow release if a 30-degree arthroscope is inadequate to view around the corner [59].

Classification

  • There is a lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain [21].
  • Considerable terminological heterogeneity exists in the description of lateral elbow pain (LEP) [21].
  • The terms 'lateral epicondylitis' and 'tennis elbow' should be replaced by 'lateral elbow tendinopathy' because the condition is degenerative rather than inflammatory [52].
  • Lateral elbow tendinopathy is encountered more often among workers than tennis players [52].
  • A novel MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis [25].
  • There is a wide choice and usage of clinical rating systems in the elbow literature [37].

Clinical Presentation

  • Tennis elbow is a common problem [2].
  • Approximately 90% of people with untreated tennis elbow achieve symptom resolution at 1 year [7].
  • Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year, and the probability of recovery remained fairly constant over that timespan regardless of prior symptom duration [8].
  • Over 90% of patients with persistent tennis elbow symptoms experienced improvement without surgery [11].
  • The transient symptoms of tennis elbow reflect the natural course of a self-limiting condition [12].
  • Persistent tennis elbow symptoms have little prognostic value for predicting non-recovery [5].
  • Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it [6].
  • Patients are unable to reliably predict who will or will not improve with nonoperative treatment [6].
  • The concept that surgery is indicated if symptoms persist for an arbitrary duration is undermined by the constant probability of recovery over time [8].
  • Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET) [15].
  • Physical examination of the elbow is a critical component in formulating an accurate diagnosis [10].
  • There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP) [21].
  • Tennis elbow is characterized by stenosing changes in the orbicular ligament and tendinitis of the common extensor origin [17].
  • Tennis elbow is a degenerative process characterized by angiofibroblastic hyperplasia rather than an inflammatory condition [34].

Investigations

  • The proposed MRI classification is one of the most reliable methods to define stages of chronic lateral epicondylitis [25].
  • MRI is an important decision-making tool in the surgical treatment of refractory tennis elbow [47].
  • Computed tomography arthrography (CTA) is a reliable and accurate diagnostic modality compared with MRI to detect capsular tears in patients with chronic tennis elbow [50].
  • Increased MRI signal in the extensor carpi radialis brevis (ECRB) origin is common in both symptomatic and asymptomatic elbows [54].
  • The coronoid opening angle can be of value alongside 3-dimensional imaging in evaluating elbow injuries and used as an adjunct in clinical decision making [58].
  • Oedema is commonly found in asymptomatic elbows, necessitating the presence of thickening or tears in the common extensor origin (CEO) tendon to objectively diagnose tennis elbow on MRI [60].
  • There should be an emphasis on not overanalyzing and treating based on MRI findings alone for young patients with elbow dislocations [61].
  • The diagnostic and prognostic value of MRI imaging in lateral epicondylar tendinopathy is called into question, especially in older patients [62].
  • Post-traumatic osteoarthritis of the elbow is an uncommon condition where clinical manifestations often vary from radiological findings [63].
  • Autologous tenocyte injection significantly improved clinical function and MRI tendinopathy scores for up to 5 years in patients with chronic resistant lateral epicondylitis who had previously undergone unsuccessful nonsurgical treatment [64].
  • The lack of both neovascularity and grey scale changes on ultrasound examination substantially increases the probability that lateral elbow tendinopathy is not present and should prompt consideration of other causes for lateral elbow pain [65].
  • The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity and indicate those who may not respond to nonoperative therapy [66].
  • Sonography has no prognostic value for predicting the effectiveness of brace only, physical therapy only, or a combination of these strategies in patients with tennis elbow [68].
  • Patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament [69].
  • Ultrasound (US) and color Doppler (CD) guided intratendinous injections gave pain relief in patients with tennis elbow [70].

Treatment

Natural History and Non-Operative Management

  • Tennis elbow resolves by 6 months in most cases regardless of the treatment used [2].
  • Surgeons are unable to reliably predict which patients will or will not improve with nonoperative treatment [6].
  • About 90% of people with untreated tennis elbow achieve symptom resolution at 1 year based on placebo or no-treatment control arms of randomized trials [7].
  • Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management [41].

Operative and Interventional Management

  • Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols, but refractory cases may benefit from interventional therapies or surgical approaches [41].
  • Percutaneous ultrasonic tenotomy is a safe and effective treatment for chronic medial and lateral elbow tendinosis, producing statistically significant improvements in pain and function over a 1-year follow-up period [13].
  • Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up [18].
  • Autologous tenocyte injection (ATI) showed significantly improved clinical function and structural repair at the origin of the common extensor tendon in patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of nonoperative treatment [14].
  • Injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma (STR/PRP) is a safe treatment that effectively induces clinically significant improvements in elbow symptoms, general well-being, objective measures of strength, and imaging of the common extensor tendon within 6 months for elbow tendinopathy recalcitrant to standard treatments [35].
  • Similar outcomes in pain improvement and return to work may be achievable with either platelet-rich plasma (PRP) injections or surgery in recalcitrant lateral elbow tendinosis [36].
  • A large percentage of patients who fail conservative treatment for medial humeral epicondylitis (tendinosis) can obtain pain relief and return to activities with the described operative technique [44].
  • There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow [45].

Complications

  • Corticosteroid injections for tennis elbow worsen long-term outcomes [4].
  • Corticosteroid injection provides significant short-term benefits that are reversed after six weeks, with high recurrence rates [48].
  • Persistent tennis elbow symptoms have little prognostic value, with approximately 90% of people with untreated tennis elbow achieving symptom resolution at 1 year [7].
  • Tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment is used [2].
  • Conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union in male junior tennis players with medial epicondylar fragmentation, but elbow pain persisted in 50% of subjects at re-examination [30].

Recovery

  • The concept that surgery is indicated if symptoms persist for an arbitrary duration is undermined by the constant probability of recovery [8].
  • Conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union in male junior tennis players with medial epicondylar fragmentation of the humerus [30].
  • Elbow pain persisted in 50% of subjects with medial epicondylar fragmentation at re-examination despite spontaneous bone union [30].
  • Patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of nonoperative treatment showed significantly improved clinical function and structural repair at the origin of the common extensor tendon after autologous tenocyte injection (ATI) [14].

Key Evidence

  • [L1] Despite a wealth of research, there is no true consensus on the most efficacious management of tennis elbow especially for effective long-term outcomes. [1] (10.2147/oajsm.s10310)
  • [L5] Tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment is used, but for the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates. [2] (10.1016/j.arthro.2017.02.020)
  • [Paper] Corticosteroid injections for tennis elbow worsen the long term outcomes of patients. [4] (10.1016/j.jsams.2009.09.009)
  • [L4] Symptoms of tennis elbow have a steady half-life of three to four months, indicating that longer symptom duration does not indicate a poorer prognosis without surgery, and failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified. [5] (10.1302/0301-620x.105b2.bjj-2022-0883.r1)
  • [L2] Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it, and surgeons are unable to reliably predict who will or will not improve with nonoperative treatment. [6] (10.1097/corr.0000000000003425)
  • [L1] Based on the placebo or no-treatment control arms of randomized trials, about 90% of people with untreated tennis elbow achieve symptom resolution at 1 year. [7] (10.1097/corr.0000000000002058)
  • [L1] Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year, and the probability of recovery remained fairly constant over that timespan regardless of prior symptom duration, undermining the concept that surgery is indicated if symptoms persist for an arbitrary duration. [8] (10.1097/corr.0000000000002149)
  • [L4] This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral epicondylitis. [9] (10.1002/ajim.22140)
  • [L5] Physical examination of the elbow is a critical component in formulating an accurate diagnosis. [10] (10.5435/jaaos-d-16-00622)
  • [Paper] The commentary highlights that over 90% of patients with persistent tennis elbow symptoms experienced improvement without surgery, challenging the notion that surgical intervention is the right step for patients with longstanding symptoms. [11] (10.1097/corr.0000000000003488)
  • [L4] The transient symptoms of tennis elbow seen in these two cases reflect the natural course of a self-limiting condition. [12] (10.1007/s00167-012-1939-0)
  • [L4] Percutaneous ultrasonic tenotomy is a safe and effective treatment for chronic medial and lateral elbow tendinosis, producing statistically significant improvements in pain and function over a 1-year follow-up period. [13] (10.1016/j.jse.2014.07.017)
  • [L4] Patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of nonoperative treatment showed significantly improved clinical function and structural repair at the origin of the common extensor tendon after ATI. [14] (10.1177/0363546513504285)
  • [L3] Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET). [15] (10.1016/j.jse.2025.10.006)
  • [L4] Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. [18] (10.1177/0363546515612758)
  • [L5] Evaluation and management of elbow injuries in young athletes requires knowledge of the immature developing anatomy, injury pathophysiology, and established treatment algorithms for each diagnosis. [20] (10.1016/j.csm.2010.06.010)
  • [L1] In this SR, a considerable terminological heterogeneity emerged in the description of LEP, associated with the lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain. [21] (10.3390/healthcare10061095)
  • [L4] Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols, but when unsuccessful, surgical interventions may be performed with a high rate of success. [22] (10.1016/j.jse.2009.12.016)
  • [L4] The observed decrease in the carrying angle is a consequence of an increase in elbow flexion position dictated by the transition from a closed to open, semi‐open stances. [24] (10.1002/ksa.12016)
  • [L4] The proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis. [25] (10.1186/s12891-022-05758-z)
  • [L5] Pre-operative evaluations in elbow stiffness should identify involved articular and periarticular tissues and determine whether articular surfaces and osteoarticular congruence are preserved. [26] (10.1016/j.jisako.2023.10.009)
  • [L1] Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. [27] (10.1177/1758573217745041)
  • [L2] Although conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union, elbow pain persisted in 50% of subjects at re-examination. [30] (10.1016/j.jse.2014.06.044)
  • [L4] Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies. [31] (10.5397/cise.2023.01081)
  • [L5] Musculoskeletal ultrasonography provides a dynamic, functional assessment of elbow structures, allowing visualization of pathology under stress and motion. [32] (10.5435/jaaos-d-20-00935)
  • [L4] By combining an understanding of anatomy and biomechanics with surgical technique, the authors could reconstruct chronically dislocated joints to achieve functional and painless elbows. [33] (10.1016/j.jse.2006.09.003)
  • [L5] Tennis elbow is a degenerative process characterized by angiofibroblastic hyperplasia rather than an inflammatory condition, and proper treatment depends on understanding this pathogenesis. [34] (10.2106/00004623-199902000-00014)
  • [L4] STR/PRP is a safe treatment that effectively induces clinically significant improvements in elbow symptoms and general well-being as well as objective measures of strength and imaging of the common extensor tendon within 6 months of treatment of elbow tendinopathy recalcitrant to standard treatments. [35] (10.1016/j.jse.2018.09.007)
  • [L3] Similar outcomes in pain improvement and return to work may be achievable with either PRP injections or surgery in recalcitrant lateral elbow tendinosis. [36] (10.1007/s11552-014-9717-8)
  • [L4] This study identified a wide choice and usage of clinical rating systems in the elbow literature. [37] (10.1016/j.jse.2017.12.027)
  • [L5] Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. [38] (10.1177/0363546509350109)
  • [L4] The Boyd–McLeod procedure is an excellent option over both the short- and long-term for refractory tennis elbow. [40] (10.1177/1758573214540637)
  • [L4] Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, but refractory cases may benefit from interventional therapies or surgical approaches. [41] (10.5397/cise.2019.22.4.227)
  • [L5] The spin move is a simple maneuver that can improve exposure of the coronoid process regardless of the degree of elbow instability. [43] (10.1016/j.jse.2022.11.020)
  • [L4] There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow. [45] (10.1177/1758573217738199)
  • [L4] An internal joint stabilizer with a standardized treatment protocol could maintain concentric reduction while allowing early functional motion and improve clinical outcomes for patients with complex persistent elbow instability. [46] (10.1097/corr.0000000000002159)
  • [L4] MRI is an important decision-making tool in the surgical treatment of refractory tennis elbow. [47] (10.1016/j.jse.2004.07.011)
  • [L1] The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow. [48] (10.1136/bmj.38961.584653.ae)
  • [L2] CTA was a reliable and accurate diagnostic modality compared with MRI to detect the capsular tear in patients with chronic tennis elbow. [50] (10.1016/j.jse.2010.12.002)
  • [L5] The authors suggest that the terms 'lateral epicondylitis' and 'tennis elbow' be dropped from future publications and be replaced by 'lateral elbow tendinopathy' because the condition is degenerative rather than inflammatory and is encountered more often among workers than tennis players. [52] (10.1016/j.jhsa.2009.06.024)
  • [L5] Understanding the patterns of traumatic elbow instability helps the surgeon counsel and manage patients with these injuries. [53] (10.1016/j.jhsa.2010.05.002)
  • [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. [54] (10.1016/j.jse.2016.01.033)
  • [L5] Elbow arthroscopy has become a safer and more effective treatment modality for several elbow pathologies due to advances in equipment and surgical technique. [55] (10.5435/00124635-200810000-00003)
  • [L3] The greatest shoulder and elbow peak forces occurred in pitchers with 15° to 25° contralateral trunk tilt (three-quarter arm slot). [56] (10.1177/03635465231151940)
  • [L5] Restoration of osseous anatomy, particularly the coronoid, is a priority in restoring elbow alignment and maintaining ulnohumeral joint stability. [57] (10.1016/j.jhsa.2023.10.015)
  • [L4] It can be of value alongside 3-dimensional imaging in evaluating elbow injuries and used as an adjunct in clinical decision making. [58] (10.1016/j.jse.2021.12.039)
  • [L4] Oedema was commonly found in asymptomatic elbows, necessitating the presence of thickening or tears in the CEO tendon to objectively diagnose tennis elbow on MRI. [60] (10.1093/occmed/kqg031)
  • [L4] Given that most young patients with elbow dislocations are successfully treated without ligament repair, there should be an emphasis on not overanalyzing and treating based on MRI findings alone. [61] (10.1177/1558944720949961)
  • [L4] This draws into question the diagnostic and prognostic value of MRI imaging in lateral epicondylar tendinopathy, especially in older patients. [62] (10.1177/17585732221146731)
  • [L4] Post-traumatic osteoarthritis of the elbow is an uncommon condition where clinical manifestations often vary from radiological findings. [63] (10.1016/j.otsr.2013.11.004)
  • [L4] Autologous tenocyte injection significantly improved clinical function and MRI tendinopathy scores for up to 5 years in patients with chronic resistant lateral epicondylitis who had previously undergone unsuccessful nonsurgical treatment. [64] (10.1177/0363546515579185)
  • [L4] The lack of both neovascularity and grey scale changes on ultrasound examination also substantially increase the probability that the condition is not present and should prompt the clinician to consider other causes for lateral elbow pain. [65] (10.1136/bjsm.2007.043901)
  • [L2] The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity and indicate those who may not respond to nonoperative therapy. [66] (10.1177/0363546509359066)
  • [L1] Sonography has no prognostic value for predicting the effectiveness of brace only, physical therapy only, or a combination of these strategies in patients with tennis elbow. [68] (10.2214/ajr.04.0656)
  • [L4] Patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament. [69] (10.1016/j.jse.2012.04.008)
  • [L1] US and CD guided intratendinous injections gave pain relief in patients with tennis elbow. [70] (10.1136/bjsm.2007.042762)

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DOI: 10.1016/j.csm.2010.06.010 [21] Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews. Healthcare. 2022. DOI: 10.3390/healthcare10061095 [22] Arthroscopic tennis elbow release. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.12.016 [24] A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12016 [25] Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05758-z [26] Elbow stiffness: Arthritis and heterotopic ossification. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.10.009 [27] Surgery for tennis elbow: a systematic review. Shoulder & Elbow. 2017. 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DOI: 10.2106/00004623-199902000-00014 [35] First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow). Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.09.007 [36] A Retrospective Comparison of the Management of Recalcitrant Lateral Elbow Tendinosis: Platelet-Rich Plasma Injections versus Surgery. HAND. 2014. DOI: 10.1007/s11552-014-9717-8 [37] Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.12.027 [38] Revision Ulnar Collateral Ligament Reconstruction Using a Suspension Button Fixation Technique. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509350109 [40] The Boyd–McLeod procedure for tennis elbow: mid- to long-term results. Shoulder & Elbow. 2014. 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DOI: 10.1016/j.jse.2004.07.011 [48] 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 [50] The detection of the capsular tear at the undersurface of the extensor carpi radialis brevis tendon in chronic tennis elbow: the value of magnetic resonance imaging and computed tomography arthrography. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.12.002 [52] Lateral Elbow Tendinopathy: A Better Term Than Lateral Epicondylitis or Tennis Elbow. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.024 [53] Traumatic Elbow Instability. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.002 [54] Incidental magnetic resonance imaging signal changes in the extensor carpi radialis brevis origin are more common with age. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.01.033 [55] Elbow Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200810000-00003 [56] Effects of Contralateral Trunk Tilt on Shoulder and Elbow Injury Risk and Pitching Biomechanics in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231151940 [57] Postoperative Elbow Instability: Options for Revision Stabilization. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.10.015 [58] The coronoid opening angle: a novel radiographic technique to assess bone loss in coronoid trauma. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.12.039 [59] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE. [60] The objective diagnosis of early tennis elbow by magnetic resonance imaging. Occupational Medicine. 2003. 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