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Tennis elbow release

Surgeon-side topic for tennis elbow release. Backed by 310 articles from the corpus, retrieved via combined MeSH + title-text matching.

84 citationsUpdated Sep 2026
Illustration: Tennis elbow release

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis [1]. However, the condition often resolves spontaneously, warranting considerable circumspection before embarking on treatment [10]. Approximately 90% of people with untreated tennis elbow achieve symptom resolution at 1 year [8, 13], and the probability of recovery remains fairly constant over the first year regardless of prior symptom duration [13]. Symptoms have a steady half-life of three to four months [5], and longer symptom duration does not indicate a poorer prognosis without surgery [5]. Consequently, persistent symptoms are a poor indication for surgery because the majority of patients experience resolution without it [4]. Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment [4], and failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [5].

Surgical intervention is reserved for the small percentage of patients who do not respond to nonoperative approaches, for whom surgery provides near 90% satisfaction rates [9]. Refractory cases may benefit from interventional therapies or surgical approaches [14], and surgical interventions may be performed with a high rate of success when nonoperative treatment is unsuccessful [21]. Clinical outcome scores show improvement after arthroscopic extensor carpi radialis brevis release for refractory lateral epicondylitis [17]. The Nirschl procedure and arthroscopic extensor carpi radialis brevis débridement are comparable and highly effective techniques for chronic recalcitrant lateral elbow tendinopathy [31]. Minimally invasive percutaneous ultrasonic tenotomy provides sustained pain relief and functional improvement at 3-year follow-up [22]. Denervation of the lateral humeral epicondyle has success rates of 75% to 80% [15].

Controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases [6, 16]. No single universally accepted protocol has emerged for the treatment of epicondylitis [11]. Arthroscopic and open lateral release procedures are not the same; the arthroscopic procedure allows for full intra-articular assessment of the elbow and uses less appealing portal-site incisions compared to open procedures [18]. A randomized, double-blinded, placebo-controlled trial found that surgical excision of the degenerative portion of the ECRB failed to show additional benefit over placebo surgery [12]. Pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment compared with observation only or placebo [26]. The Patient-Rated Tennis Elbow Evaluation is not recommended as an outcome measure until further development and validation are performed [42].

Anatomy & Pathophysiology

Pathophysiology & Etiology

The pathophysiology of lateral epicondylitis is not completely understood, but histologic studies suggest it results from a failure of the inflammatory reparative mechanism of the extensor carpi radialis brevis (ECRB) due to overuse and repetitive stress activities [58]. Lateral elbow tendinopathy is a degenerative condition involving a failed healing tendon response rather than an inflammatory process [99]. This condition is characterized by disorganized collagen, an increased presence of fibroblasts, and the absence of prostaglandins and inflammatory cells [99]. The condition has a reported prevalence rate of 1% to 3% and is most often seen in active patients aged between 35 and 50 years [58]. There is a strong association between combined physical exertion and elbow movements and the development of lateral epicondylitis [41]. Contact pressure between the bone and tendon at the origin of the common extensor tendons is significantly increased with elbow extension, forearm pronation, and varus stress to the elbow under tension of the extensor tendons [65]. Patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament [39]. Instability can coexist and may be associated with refractory lateral epicondylitis [121].

Diagnosis & Terminology

Lateral elbow tendinopathy (LET) is considered the most appropriate clinical term because other terms such as lateral epicondylitis, lateral epicondylalgia, lateral epicondylosis, and tennis elbow reference inappropriate etiologic, anatomic, and pathophysiologic concepts [99]. There is considerable terminological heterogeneity in the description of lateral elbow pain, associated with a lack of clear and recognized diagnostic criteria [40]. Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy [27]. Misdiagnosis can occur in patients affected by longstanding lateral elbow pain [37]. Physical examination of the elbow is a critical component in formulating an accurate diagnosis [52]. Magnetic resonance imaging is a reliable tool in determining the radiological severity of lateral epicondylitis [43]. Increased MRI signal in the ECRB origin is common in both symptomatic and asymptomatic elbows [60]. The sonographic posterolateral rotatory stress test has high specificity and allows comparison with the contralateral elbow, making it a valuable preoperative assessment method for patients with recalcitrant tennis elbow [127].

Biomechanics & Associated Findings

Proprioception is poorer in elbows with lateral epicondylitis than in healthy controls [114]. Patients with lateral epicondylitis exhibit significant cervical proprioceptive impairments compared to healthy controls, evidenced by deficits in joint position sense, movement sense, and force sense [117]. Altered anconeus muscle activation characteristics occur during isometric gripping in individuals with lateral elbow tendinopathy compared with age- and sex-matched controls [97]. Focusing on the upper segments of the body is essential in the management of lateral epicondylitis, in addition to the elbow [23].

Classification

Arthroscopic Capsular Classification: This system categorizes lateral epicondylitis based on the relationship of the capsular fold to the radial head [57]. Type 1 is defined by complete exposure of the radial head [57]. Type 2 involves partial coverage of the radial head by the capsuloligamentous complex without interposition into the joint in any position [57]. Type 3 is characterized by subluxation of the capsular edge into the joint [57].

Baker and Jones Classification: Baker and Jones classified arthroscopic changes in lateral elbow tendinopathy into three distinct patterns [112]. Type I features inflammation and fraying deep to the extensor carpi radialis brevis with no tear [112]. Type II presents with linear tears at the undersurface of the extensor carpi radialis brevis [112]. Type III is defined by retracted, partial, or complete avulsions of the extensor carpi radialis brevis [112].

Other Considerations: A proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis [59]. Additionally, a classification model for individuals with tennis elbow categorizes patients using information from common signs and symptoms to assist therapists in identifying appropriate treatment options [103].

Clinical Presentation

Lateral epicondylitis is a common, generally self-limiting tendinosis affecting patients aged 35 to 55 years [50], with an estimated prevalence of 3% and most frequently afflicting those between the ages of 35 and 65 years [49]. The condition typically follows a self-limiting course of 12 to 18 months [34]. Approximately 20% of patients experience disabling pain that results in restriction of their professional and social lives [49]. While the transient symptoms reflect the natural course of a self-limiting condition [25], there is a lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain [40]. Consequently, misdiagnosis can occur in patients affected by longstanding lateral elbow pain [37].

Traditionally, lateral epicondylitis is a clinical diagnosis based on history and examination [49]. A clinical diagnosis is defined as pain over the lateral humeral epicondyle of at least 6 weeks’ duration provoked by palpation and resisted wrist/middle finger extension or gripping [91]. Diagnostic criteria include pain on palpation of the lateral epicondyle and the declaration of pain during provocation tests [84]. Specifically, diagnosis is based on pain located at the lateral aspect of the elbow, point tenderness over the lateral epicondyle, and a positive provocation test with reproducible pain at the lateral elbow caused by resisted wrist extension with the elbow in full extension [90].

Regarding prognosis, about 90% of people with untreated tennis elbow achieve symptom resolution at 1 year [8], and three-quarters of patients with acute lateral epicondylitis recover within 52 weeks [51]. The probability of recovery from tennis elbow remained fairly constant over a one-year timespan regardless of prior symptom duration [13]. Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it [4]. Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment for chronic tennis elbow [4].

Investigations

MRI: Magnetic resonance imaging is a reliable tool for determining the radiological severity of lateral epicondylitis [43]. A proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis [59]. Increased MRI signal in the extensor carpi radialis brevis origin is common in both symptomatic and asymptomatic elbows [60]. Although there is variation in the use of MRI for lateral epicondylitis and its use is associated with downstream effects, the routine use of MRI for the diagnosis of lateral epicondylitis is low [110]. Despite MRI evidence of a partial ECRB tear, nonsurgical treatment may be a viable option for some patients with recalcitrant lateral epicondylitis [111]. The clinical use of MRI in the management of patients with enthesopathy of the ECRB origin merits further study [120]. In recovered and unrecovered groups, improvement of tendinopathy area was 60% versus 16%, indicating that postoperative MRI findings reflect clinical outcomes [128].

CTA: Computed tomography arthrography was a reliable and accurate diagnostic modality compared with MRI to detect the capsular tear in patients with chronic tennis elbow [115].

Treatment

Non-Operative

Approximately 90% of individuals with untreated tennis elbow achieve symptom resolution within one year [8]. The probability of recovery remains fairly constant over the first year regardless of prior symptom duration [13], and symptoms exhibit a steady half-life of three to four months, indicating that longer symptom duration does not predict a poorer prognosis without surgery [5]. Surgeons are unable to reliably predict which patients will improve with nonoperative treatment [4]. In the majority of patients (greater than 90%), lateral epicondylitis is successfully treated nonoperatively [45]. At best, all nonsurgical treatments provided only small pain relief while increasing the odds of adverse events [113]. Specific interventions include autologous tenocyte injection, which 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 [19]. Ultrasonographically guided percutaneous radiofrequency lesioning can be considered as an alternative treatment for recalcitrant lateral epicondylitis before further surgical intervention [93]. Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis [132]. The author recommends against using platelet-rich plasma or autologous blood injections in patients with lateral epicondylitis [94]. One patient treated with botulinum toxin injection to the extensor carpi radialis brevis experienced complete pain resolution and regained wrist extension strength by 3 months [67].

Operative

Indications: Surgery is indicated for the small percentage of patients who do not respond to nonoperative approaches, providing near 90% satisfaction rates [9]. Surgical release of the fibrous attachments to the epicondyle is effective for patients with persistent epicondylitis who have failed conservative therapy, with 95.9% achieving excellent or good results [131].

Surgical Approach / Technique: Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis [30, 35]. The arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period [28]. In a study of 30 patients with recalcitrant symptoms, arthroscopic resection of the radiocapitellar capsular complex resulted in complete relief of symptoms in 28 patients within 2 weeks of surgery [57]. The average time until return to work after arthroscopic resection of the radiocapitellar capsular complex was 7 days [57]. Both the Nirschl procedure and arthroscopic extensor carpi radialis brevis débridement are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy [31]. With the number of available participants, a study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow [12]. While symptoms of refractory lateral humeral epicondylitis can be successfully treated by lateral humeral epicondylectomy, this success may be achieved through the denervation component rather than the release of the common extensor muscle origins [66]. Denervation surgery for lateral epicondylitis of the elbow was effective for pain relief among patients showing a positive response to the block test [109]. Denervation of the lateral humeral epicondyle is one of many procedures described for the treatment of chronic tennis elbow, with success rates of 75% to 80% [15]. Patients who received a suture anchor for functional recovery in the surgical treatment of tennis elbow had faster rehabilitation at 6 weeks postoperatively in terms of both functional outcome scores and grip and wrist extension strength measures [133]. No technique appears superior by any measure among open, percutaneous, and arthroscopic approaches for treating lateral epicondylitis [45]. Arthroscopic and open lateral release procedures are not the same, with distinct advantages for the arthroscopic procedure including the capability to fully assess the elbow intra-articularly and the use of less appealing portal-site incisions [18].

In arthroscopic tennis elbow release, the patient is placed in the lateral decubitus position with the arm hanging over an armrest with the elbow at 90 degrees [48]. A proximal anteromedial portal for viewing with a 30° 4.0-mm arthroscope is established, and a 3-mm outflow cannula is introduced through a posterolateral portal [48]. A modified working portal is established directly anterior to the lateral epicondyle at the border of the proximal attachment of the ECRB tendon as close to bone as possible [48]. The anterolateral capsule is released from the upper border of the lateral epicondyle down to the annular ligament with a 3.5-mm single-use bipolar radiofrequency electrode in vaporization mode [48]. The ECRB tendon is released from its bony insertion starting in the interval between the extensor carpi radialis longus and ECRB tendons [48].

In the Baker and Cummings technique, the patient is placed prone on the operating table with the affected extremity supported by a precut foam holder with the shoulder abducted to 90 degrees [55]. The joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [55]. The proximal medial or superomedial portal is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [55]. A 2.7-mm, 30-degree arthroscope is inserted into the joint to perform the diagnostic portion of the procedure [55]. The superolateral portal is established with an 18-gauge needle through the lesion after pathologic tissue is identified [55]. The capsule is excised with a full-radius resector to identify the undersurface of the extensor carpi radialis brevis tendon [55]. The capsule and pathologic tendinous attachment of the ECRB are debrided with a curet and motorized shaver, and the lateral epicondyle is decorticated [55]. Decortication of the lateral epicondyle and lateral epicondylar ridge can be done with an arthroscopic burr, handheld instruments, or electrocautery [55].

In extra-articular arthroscopic release, the patient is placed in a lateral decubitus position with the arm positioned prone over a mid-humeral support with a tourniquet [100]. 15 ml of normal saline is injected into the elbow joint from the posterolateral soft spot to inflate the capsule [100]. A standard proximal-medial portal is used to gain access into the anterior compartment of the elbow, ensuring protection of the antebrachial cutaneous and ulnar nerves [100]. An accessory proximal lateral portal is created that triangulates the area centered over the premarked lateral epicondylar point of maximal tenderness [100]. A 4-mm shaver is introduced into the accessory proximal lateral portal to shave bursal tissue and visualize the ECRB origin [100]. The ECRB origin on the humeral lateral condylar ridge in the region of the tender area is completely debrided [100].

In open release, a 7.5-cm incision is made from 2.5 cm proximal to the lateral epicondyle to 5 cm distal to it, curving gently anteriorly [125]. The ECRL is dissected from the aponeurosis proximally to the lateral epicondyle and distally to the level of the radial head [125]. The origin of the ECRB is incised and released by sharp dissection off the bone, encompassing approximately 75% of the tendinous origin [125].

In denervation surgery, a 3- to 4-cm transverse or horizontal incision is made 2 fingerbreadths proximal to the lateral epicondyle [130]. The posterior branches of the posterior cutaneous nerve of the forearm (PBPCNF) are identified and distinguished from the main posterior cutaneous nerve of the forearm (PCNF) [130]. Gentle traction on the PCNF results in skin movement distally in the forearm, whereas gentle traction on the PBPCNF results in subtle skin movement over the lateral epicondyle [130].

Complications and Considerations: Nerve injuries resulting from arthroscopic treatment of lateral epicondylitis include posterior interosseous nerve transection and partial median nerve laceration [61]. Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management [33]. The outcome of release of the flexor muscle for patients with medial epicondylitis alone was comparable with previously reported results, but the outcome was unsatisfactory for patients with coexistent ulnar neuritis [7].

Complications

Stiffness / Arthrofibrosis: Heterotopic ossification has been reported as a complication following elbow arthroscopy for lateral epicondylitis [64]. A slight limitation in range of motion is a possible undesired consequence of arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow [69].

Nerve palsy: In a series of surgical repairs for refractory medial epicondylitis, there were no significant complications, including ulnar nerve injuries [123].

Infection (PJI): In the same series of surgical repairs for refractory medial epicondylitis, there were no significant complications, including infections [123].

Other Considerations: The incidence of failure requiring revision surgery for lateral epicondylitis is 1.5% in the studied population [135]. Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis [135]. One patient in a series of medial epicondylitis repairs required reoperation for pain and retearing at 1.5 years after the index procedure [123]. Both arthroscopic and open debridement of the extensor carpi radialis brevis for lateral epicondylitis have low rates of 90-day adverse events [122]. There are no significant differences in 90-day adverse event rates between arthroscopic and open debridement for lateral epicondylitis [122].

Recovery

Other Considerations: Tennis elbow surgery provides near 90% satisfaction rates for the small percentage of patients who do not respond to nonoperative approaches [9]. Denervation of the lateral humeral epicondyle is one of many procedures described for the treatment of chronic tennis elbow, with success rates of 75% to 80% [15]. Acute lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks [51]. The concept that surgery is indicated if symptoms persist for an arbitrary duration is undermined by the constant probability of recovery over time [13].

At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy demonstrated good durability of pain relief and functional recovery [137]. Ultrasonic percutaneous tenotomy was accompanied by sustained sonographic tissue healing with no significant deterioration at 90 months [137].

Key Evidence

  • [L4] Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. [1] (10.1016/j.jhsa.2009.02.006)
  • [L2] This document is a study protocol describing the design of a prospective, randomized sham-controlled trial to determine the efficacy of arthroscopic tennis elbow release; it does not report results or conclusions from completed data collection. [2] (10.1186/s12891-016-1093-9)
  • [L1] Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. [3] (10.1016/j.jhsa.2018.06.009)
  • [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. [4] (10.1097/corr.0000000000003425)
  • [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)
  • [L5] This article serves to provide an updated review of the various treatment options and management for lateral epicondylosis, noting that while most patients experience relief with non-operative management, controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases. [6] (10.1016/j.jhsa.2024.07.003)
  • [L4] The results of release of the flexor muscle for patients with medial epicondylitis alone were comparable with previously reported results, but the outcome was unsatisfactory for patients with coexistent ulnar neuritis. [7] (10.2106/00004623-199509000-00014)
  • [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. [8] (10.1097/corr.0000000000002058)
  • [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. [9] (10.1016/j.arthro.2017.02.020)
  • [L4] Overall, the available data suggest that lateral epicondylitis often resolves spontaneously, warranting considerable circumspection before embarking on treatment. [10] (10.1016/j.otsr.2019.09.004)
  • [L5] This article is a review of recently published information on elbow tendinopathy and tendon ruptures intended to assist clinicians in diagnosis and management, noting that while numerous treatment options exist for epicondylitis, no single universally accepted protocol has emerged. [11] (10.1016/j.jhsa.2009.01.022)
  • [L2] With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow. [12] (10.1177/0363546517753385)
  • [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. [13] (10.1097/corr.0000000000002149)
  • [L4] Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, but refractory cases may benefit from interventional therapies or surgical approaches. [14] (10.5397/cise.2019.22.4.227)
  • [L5] The authors of the original study note that denervation of the lateral humeral epicondyle is one of many procedures described for the treatment of chronic tennis elbow, with success rates of 75% to 80%, and suggest that whether denervation is the mechanism of action for procedures involving an incision around the elbow might be answered by a randomized clinical trial. [15] (10.1177/0363546518783976)
  • [L4] Although many treatments have been advocated for lateral epicondylitis, there is little clear consensus on which modality works best for both conservative and operative options, indicating that the understanding of the disease process is currently incomplete. [16] (10.1016/j.jhsa.2007.07.019)
  • [L4] Overall, clinical outcome scores showed improvement after arthroscopic extensor carpi radialis brevis release for refractory lateral epicondylitis. [17] (10.1016/j.arthro.2015.02.006)
  • [L5] Arthroscopic and open lateral release procedures are not the same, with distinct advantages for the arthroscopic procedure including the capability to fully assess the elbow intra-articularly and the use of less appealing portal-site incisions. [18] (10.1016/j.arthro.2018.08.010)
  • [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. [19] (10.1177/0363546513504285)
  • [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. [21] (10.1016/j.jse.2009.12.016)
  • [L4] Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. [22] (10.1177/0363546515612758)
  • [L3] In addition to the elbow, focusing on the upper segments is essential in the management of LE. [23] (10.1016/j.jse.2018.12.010)
  • [L4] The transient symptoms of tennis elbow seen in these two cases reflect the natural course of a self-limiting condition. [25] (10.1007/s00167-012-1939-0)
  • [L1] Pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment of lateral epicondylitis compared with observation only or placebo. [26] (10.1007/s11999-014-4022-y)
  • [L3] Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET). [27] (10.1016/j.jse.2025.10.006)
  • [L4] The arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period. [28] (10.1007/s00167-005-0662-5)
  • [L2] Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. [30] (10.1016/j.arthro.2020.12.054)
  • [L3] Both techniques are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy. [31] (10.1016/j.jse.2016.09.022)
  • [L5] Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management. [33] (10.1016/j.xrrt.2023.07.006)
  • [L5] Lateral epicondylitis is a common condition with a self-limiting course of 12 to 18 months, and most patients are well-managed with non-operative treatment and activity modification, though many surgical techniques exist for refractory symptoms. [34] (10.1302/2058-5241.1.000049)
  • [L4] Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. [35] (10.1016/j.arthro.2012.04.109)
  • [L4] A misdiagnosis can occur in patients affected by longstanding lateral elbow pain. [37] (10.1177/03635465251319545)
  • [L4] Patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament. [39] (10.1016/j.jse.2012.04.008)
  • [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. [40] (10.3390/healthcare10061095)
  • [L4] This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral epicondylitis. [41] (10.1002/ajim.22140)
  • [L2] It is not recommended for use as an outcome measure in studies evaluating interventions for lateral epicondylitis until further development and validation are performed. [42] (10.1258/ht.2010.010014)
  • [L2] Magnetic resonance imaging is a reliable tool in determining radiological severity of lateral epicondylitis. [43] (10.1016/j.jhsa.2010.11.040)
  • [L4] [45] (10.1097/blo.0b013e3181483dc4)
  • [L4] [48] (10.1016/j.arthro.2015.10.008)
  • [L4] [49] (10.1177/17585732221146731)
  • [L5] Lateral epicondylitis is a common, generally self-limiting tendinosis affecting patients aged 35 to 55 years. [50] (10.1302/0301-620x.95b9.29285)
  • [L1] Acute lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks. [51] (10.1186/s12891-015-0582-6)
  • [L5] Physical examination of the elbow is a critical component in formulating an accurate diagnosis. [52] (10.5435/jaaos-d-16-00622)
  • [L4] [57] (10.1097/01.blo.0000176143.08886.fe)
  • [L4] [58] (10.1016/j.arthro.2017.01.042)
  • [L4] The proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis. [59] (10.1186/s12891-022-05758-z)
  • [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. [60] (10.1016/j.jse.2016.01.033)
  • [L4] [61] (10.1016/j.jhsa.2012.01.038)
  • [L4] To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. [64] (10.1177/1558944716668844)
  • [L5] Contact pressure between the bone and tendon at the origin of the common extensor tendons is significantly increased with elbow extension, forearm pronation, and varus stress to the elbow under tension of the extensor tendons. [65] (10.1016/j.jhsa.2010.10.005)
  • [L4] While symptoms of refractory lateral humeral epicondylitis can be successfully treated by lateral humeral epicondylectomy, this success may be achieved through the denervation component rather than the release of the common extensor muscle origins. [66] (10.1007/s11552-011-9318-8)
  • [L4] The patient experienced complete pain resolution and regained wrist extension strength by 3 months. [67] (10.1177/1753193410383600)
  • [L4] A slight limitation in range of motion is a possible undesired consequence of this intervention. [69] (10.1007/s00167-017-4531-9)
  • [L2] [84] (10.1186/s13018-021-02602-3)
  • [L2] [90] (10.1016/j.jse.2014.01.020)
  • [L1] [91] (10.1186/s12891-019-2905-5)
  • [L4] This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention. [93] (10.1177/0363546511417096)
  • [L5] The author recommends against using these injections in patients with lateral epicondylitis. [94] (10.1097/corr.0000000000001249)
  • [L3] [97] (10.1016/j.jse.2024.11.001)
  • [L5] [99] (10.1177/1558944718794008)
  • [L3] [100] (10.1016/j.xrrt.2021.07.005)
  • [L5] [103] (10.1016/j.jht.2012.06.007)
  • [L4] Our strategy of denervation surgery for lateral epicondylitis of the elbow was effective for pain relief among patients showing a positive response to the block test. [109] (10.1016/j.jses.2019.10.102)
  • [L3] Although there is variation in the use of MRI for lateral epicondylitis and its use is associated with downstream effects, the routine use of MRI for the diagnosis of lateral epicondylitis is low. [110] (10.1016/j.jhsa.2023.03.025)
  • [L3] Despite MRI evidence of a partial ECRB tear, nonsurgical treatment may be a viable option for some patients with recalcitrant lateral epicondylitis. [111] (10.1016/j.jseint.2021.11.017)
  • [L4] [112] (10.1111/sae.12025)
  • [L1] At best, all treatments provided only small pain relief while increasing the odds of adverse events. [113] (10.1177/0363546518801914)
  • [L3] Proprioception seems to be poorer in elbows with lateral epicondylitis than in the controls' elbows, which needs to be taken into consideration in the management of lateral epicondylitis. [114] (10.1016/j.jse.2007.07.003)
  • [L2] CTA was a reliable and accurate diagnostic modality compared with MRI to detect the capsular tear in patients with chronic tennis elbow. [115] (10.1016/j.jse.2010.12.002)
  • [L3] This study demonstrated that patients with lateral epicondylitis exhibit significant cervical proprioceptive impairments compared to healthy controls, as evidenced by deficits in joint position sense, movement sense, and force sense. [117] (10.1186/s12891-025-09026-8)
  • [L3] The clinical use of MRI in the management of patients with enthesopathy of the ECRB origin merits further study. [120] (10.1016/j.jhsa.2009.02.023)
  • [L1] Instability can coexist and may be associated with refractory lateral epicondylitis. [121] (10.1177/0363546520980133)
  • [L3] For lateral epicondylitis, both arthroscopic and open debridement of the extensor carpi radialis brevis were found to have low rates of 90-day adverse events, with no significant differences between the 2 approaches. [122] (10.1016/j.arthro.2022.08.022)
  • [L4] [123] (10.1016/j.jse.2015.03.017)
  • [L2] [125] (10.1016/j.arthro.2018.07.008)
  • [L1] Its high specificity and ability to compare with the contralateral elbow make it a valuable preoperative assessment method, particularly in patients with recalcitrant tennis elbow. [127] (10.1016/j.jse.2025.08.015)
  • [L4] In the recovered and unrecovered groups, improvement of tendinopathy area was 60% versus 16%, indicating that postoperative MRI findings reflect clinical outcomes. [128] (10.1016/j.arthro.2022.07.019)
  • [L4] [130] (10.1016/j.jhsa.2012.10.033)
  • [L4] Surgical release of the fibrous attachments to the epicondyle is effective for patients with persistent epicondylitis who have failed conservative therapy, with 95.9% achieving excellent or good results. [131] (10.2106/00004623-195335020-00015)
  • [L1] Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis. [132] (10.1177/0363546508318045)
  • [L1] Patients who received a suture anchor did have faster rehabilitation at 6 weeks postoperatively in terms of both functional outcome scores and grip and wrist extension strength measures. [133] (10.1016/j.jse.2022.11.019)
  • [L4] The incidence of failure requiring revision surgery for lateral epicondylitis in the studied population is low (1.5%). [135] (10.1016/j.jse.2016.10.022)
  • [L4] At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy demonstrated good durability of pain relief and functional recovery that was previously achieved, accompanied by sustained sonographic tissue healing with no significant deterioration. [137] (10.1177/03635465211010158)

See Also

References

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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.

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