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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.

Overview

Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis [1], yet persistent symptoms remain a poor indication for surgery given that the majority of patients experience resolution without intervention [2]. Approximately 90% of untreated individuals achieve symptom resolution by one year, with a steady symptom half-life of three to four months [5, 9]. Recovery probability remains fairly constant over a one-year timespan regardless of prior symptom duration, and longer duration does not indicate a poorer prognosis [5, 9]. Consequently, most cases respond to appropriate nonoperative protocols, and surgery should be considered discretionary only if it outperforms the natural history of disease and placebo interventions [6, 15, 17].

Surgeons are currently unable to reliably predict which patients will or will not improve with nonoperative treatment [2]. While pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment compared with observation or placebo [18], failed nonoperative treatment should not serve as a surgical indication unless reliable predictors of non-recovery are identified [9]. For the small percentage of patients who do not respond to nonoperative approaches, surgery yields near 90% satisfaction rates [6]. However, controversy persists regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases [4]. Specific technical variations, such as radial nerve release or excision of the degenerative ECRB portion, have failed to demonstrate additional benefit over placebo surgery or standard treatment [7, 11].

Anatomy & Pathophysiology

Diagnosis of lateral epicondylitis relies on a critical physical examination of the elbow, though considerable terminological heterogeneity exists due to a lack of clear diagnostic criteria [24][29]. While increased MRI signal in the extensor carpi radialis brevis origin is common in both symptomatic and asymptomatic elbows, proprioception is significantly poorer in affected elbows compared to healthy controls [30][51]. Patients with lateral epicondylitis also exhibit significant cervical proprioceptive impairments, evidenced by deficits in joint position sense, movement sense, and force sense [53].

Kinematics & Biomechanics: Contact pressure between the bone and tendon at the common extensor tendon origin increases significantly with elbow extension, forearm pronation, and varus stress under extensor tendon tension [54]. The condition is characterized by an adaptive motor pattern involving increased relative activation and coactivation of the anconeus muscle depending on grip force [39]. Management must focus on upper segments, including scapular position and upper extremity muscle strength, as these are essential for treating lateral epicondylitis [8].

Surgical Approach & Technique: Arthroscopic and open lateral release procedures are distinct, with arthroscopic options offering the capability to fully assess the elbow intra-articularly, though they utilize less appealing portal-site incisions [19]. The proximal medial or superomedial portal is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [26]. During release, the trocar is directed toward the radial head while maintaining contact with the anterior aspect of the humerus [26]. The extensor carpi radialis brevis tendon origin is identified by excising the capsule to view its undersurface [26]. Decortication of the lateral epicondyle and lateral epicondylar ridge can be performed with an arthroscopic burr, handheld instruments, or electrocautery [26]. While a 30-degree arthroscope is adequate for most of the procedure, a 70-degree arthroscope may be required in rare instances [26].

Outcomes & Complications: Arthroscopic tennis elbow release provides symptomatic improvement in most patients [1]. Elbow arthroscopy has become a safer and more effective treatment modality for several elbow pathologies due to advances in equipment and surgical technique [37]. However, heterotopic ossification can develop after elbow arthroscopy for lateral epicondylitis [31]. Most top-cited articles in elbow arthroscopy comprise case series exhibiting Level IV or V evidence [32].

Conservative Management: Both orthoses improve elbow proprioception, pain severity, and force production in the hand in patients with lateral elbow tendinopathy [38]. Counterforce bracing provides a significant reduction in the frequency and severity of pain in the short term (2-12 weeks) compared with a placebo brace and improves overall elbow function at 26 weeks [45]. Clinical parameters of lateral epicondylitis may be influenced by several factors [46].

Classification

Natural History and Indication: Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it [2]. Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year [5], and the probability of recovery remained fairly constant over the timespan regardless of prior symptom duration [5]. Tennis elbow resolves by 6 months in most cases no matter what treatment is used [6], undermining the concept that surgery is indicated if symptoms persist for an arbitrary duration [5]. Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment of chronic tennis elbow [2]. Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management [10].

Refractory Management: For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates [6]. Refractory cases of lateral epicondylitis may benefit from interventional therapies or surgical approaches [10]. Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis [1] and is a valid technique for the treatment of recalcitrant lateral epicondylitis [41, 42]. 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% [14]. Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement [7].

Diagnostic and Therapeutic Uncertainty: There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP) [29], and a lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain [29]. The understanding of the disease process for lateral epicondylitis is currently incomplete [28]. There is little clear consensus on which modality works best for both conservative and operative options for lateral epicondylitis [28]. Controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases of lateral epicondylitis [4]. Failed surgical treatment of lateral epicondylitis is multifactorial [22], and distinguishing the cause of failed surgical treatment is critical for appropriate management [22]. Focusing on the upper segments in addition to the elbow is essential in the management of lateral epicondylalgia [8].

Other Considerations: The evidence base highlights that while surgery is an option for recalcitrant cases, the natural history of the condition favors nonoperative management for the vast majority, and no single classification system or modality has emerged as definitively superior for all patients.

Clinical Presentation

Tennis elbow is a common condition characterized by a self-limiting course, with resolution occurring in most cases within 6 to 18 months regardless of the treatment modality utilized [6, 25]. Approximately 90% of patients achieve symptom resolution by one year, a rate consistent across placebo and no-treatment control arms of randomized trials [5, 13]. The probability of recovery remains fairly constant over time regardless of prior symptom duration, with symptoms exhibiting a steady half-life of three to four months [5, 9]. Acute lateral epicondylitis is similarly self-limiting, with three-quarters of patients recovering within 52 weeks [23].

Given this natural history, persistent symptoms are a poor indication for surgery as the majority of patients experience resolution without intervention [2]. Longer symptom duration does not correlate with a poorer prognosis in the absence of surgery [9]. Consequently, failed nonoperative treatment should not serve as an indication for surgery unless reliable predictors of non-recovery are identified [9]. Surgeons are currently unable to reliably predict which patients will or will not improve with nonoperative management of chronic tennis elbow [2].

Diagnostic accuracy is critical given that nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET) [20]. Physical examination of the elbow is a critical component in formulating an accurate diagnosis [24].

Investigations

Plain radiography: While not explicitly detailed in the provided evidence base, the low routine use of advanced imaging suggests plain radiographs remain the initial standard, though specific signs like Pellegrini–Stieda lesions are not cited here.

MRI: Magnetic resonance imaging is a reliable tool for determining the radiological severity of lateral epicondylitis [44], yet its routine use for diagnosis remains low [48]. Increased MRI signal in the extensor carpi radialis brevis (ECRB) origin is common in both symptomatic and asymptomatic elbows and correlates with increasing age [30]. Despite MRI evidence of a partial ECRB tear, nonsurgical treatment may still be a viable option for some patients with recalcitrant lateral epicondylitis [49]. Postoperative MRI findings reflect clinical outcomes, with recovered groups showing a 60% improvement in tendinopathy area versus 16% in unrecovered groups [58]. However, the diagnostic and prognostic value of MRI in lateral elbow tendinopathy is questionable, particularly in older patients [52], and its clinical use in managing ECRB origin enthesopathy merits further study [57].

Other Considerations: Persistent tennis elbow symptoms are a poor indication for surgery, as the majority of patients experience symptom resolution without it [2]. Surgeons are unable to reliably predict which patients will or will not improve with nonoperative treatment of chronic tennis elbow [2]. Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET) [20]. Additionally, patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament [59].

Treatment

Non-Operative

Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections [34]. Most patients with lateral epicondylitis are well-managed with non-operative treatment and activity modification [25], with approximately 90% of people achieving symptom resolution by 1 year without intervention [5]. Symptoms have a steady half-life of three to four months, and the probability of recovery remains fairly constant over the first year regardless of prior symptom duration [5]. The condition follows a self-limiting course of 12 to 18 months, resolving by 6 months in most cases regardless of the treatment used [6]. Persistent symptoms are a poor indication for surgery as the majority of patients experience resolution without it [2]. Longer symptom duration does not indicate a poorer prognosis without surgery [9], and surgeons are unable to reliably predict who will or will not improve with nonoperative treatment [2]. Consequently, failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [9].

Pooled data from randomized controlled trials indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment compared with observation only or placebo [18]. At best, all nonsurgical treatments for enthesopathy of the extensor carpi radialis brevis provided only small pain relief while increasing the odds of adverse events [50]. Platelet-rich plasma or autologous blood injections do not reduce pain or improve function in patients with lateral epicondylitis [36]. Management ranges from simple analgesia and conservative therapies to surgical intervention for refractory cases [43]. Surgeons should explore other innovative treatments that either actively improve pain relief or accelerate the rate of soft tissue healing [21].

Operative

Indications: Surgery is reserved for the small percentage of patients who do not respond to nonoperative approaches, providing near 90% satisfaction rates in this cohort [6]. Refractory cases of lateral epicondylitis may benefit from interventional therapies or surgical approaches [10]. Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis [1].

Surgical Approach / Technique: 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 [19]. The arthroscopic tennis elbow release technique involves placing the patient prone with two rolled towels longitudinally under the thorax [26]. The affected extremity is positioned with the ipsilateral shoulder abducted to 90 degrees and supported by a precut foam holder [26]. The joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [26]. A proximal medial or superomedial portal is established approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [26]. A trocar and sheath are introduced anterior to the intermuscular septum, maintaining contact with the anterior aspect of the humerus as the trocar is directed toward the radial head [26]. A 2.7-mm, 30-degree arthroscope is inserted into the joint for the diagnostic portion of the procedure, though a 70-degree arthroscope may be required in rare instances [26]. A superolateral portal is established with an 18-gauge needle through the lesion after identifying pathologic tissue [26]. A full-radius resector is used to excise the capsule to identify the undersurface of the extensor carpi radialis brevis tendon [26]. A curet and motorized shaver debride the capsule and the pathologic tendinous attachment of the extensor carpi radialis brevis [26]. The lateral epicondyle and lateral epicondylar ridge are decorticated using an arthroscopic burr, handheld instruments, or electrocautery [26]. Arthroscopic release is a reproducible method with a marked postoperative increase in function within a short rehabilitation period [16].

Implant Selection: Patients who received a suture anchor for surgical treatment of tennis elbow had faster rehabilitation at 6 weeks postoperatively in terms of functional outcome scores and grip and wrist extension strength measures [61].

Adjuncts: Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement [7]. A study failed to show additional benefit of the surgical excision of the degenerative portion of the extensor carpi radialis brevis over placebo surgery for the management of chronic tennis elbow [11]. 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% [14]. Denervation surgery was effective for pain relief among patients showing a positive response to the block test [47]. Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis [60].

Other Considerations: Focusing on the upper segments in addition to the elbow is essential in the management of lateral epicondylitis [8].

Complications

Natural History and Indication: Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it [2]. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year [5], a probability that remains fairly constant over time regardless of prior symptom duration [5]. 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 [13]. Tennis elbow is a common problem that resolves by 6 months in most cases regardless of treatment used [6]. Pooled data from randomized controlled trials indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment of lateral epicondylitis compared with observation only or placebo [18]. Surgical excision of the degenerative portion of the ECRB failed to show additional benefit over placebo surgery for the management of chronic tennis elbow [11]. Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement [7]. Success in treating refractory lateral humeral epicondylitis via lateral humeral epicondylectomy may be achieved through the denervation component rather than the release of the common extensor muscle origins [69].

Infection and Wound Complications: The risk of complications is similar regardless of whether open or arthroscopic release techniques are used [64]. Patients may be counseled that their risk of infectious complications may be slightly higher with open releases compared to other techniques [64]. Open surgical techniques for lateral epicondylitis offer excellent results with a low rate of complications at a mean follow-up of 9.8 years [70].

Stiffness and Heterotopic Ossification: 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 [67]. Heterotopic ossification development has been reported after elbow arthroscopy for lateral epicondylitis [31].

Other Considerations: The incidence of failure requiring revision surgery for lateral epicondylitis is low (1.5%) [65]. Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis [65].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily living within the first few weeks following arthroscopic release, which is associated with a marked postoperative increase in function within a short rehabilitation period [16].

Full activity (months): While arthroscopic tennis elbow release provides symptomatic improvement in most patients [1], the natural history of the condition dictates that symptoms resolve by 6 months in most cases regardless of the treatment used [6]. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year [5, 13], and about 3/4 of patients with acute lateral epicondylitis recover within 52 weeks [23]. The probability of recovery remains fairly constant over time regardless of prior symptom duration [5], and symptoms exhibit a steady half-life of three to four months [9].

Complete recovery / outcome plateau (months): For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates [6]. Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up [63], while 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 [40].

Rehabilitation protocol: Arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period [16]. However, controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases [4].

Functional milestones: A prospective, randomized, double-blinded, placebo-controlled clinical trial failed to show additional benefit of surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow [11].

Other Considerations: Persistent tennis elbow symptoms are a poor indication for surgery because the majority of patients experience symptom resolution without it [2]. Surgeons are unable to reliably predict which patients will or will not improve with nonoperative treatment [2], and failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [9]. Focusing on upper segments in addition to the elbow is essential in the management of lateral epicondylalgia [8].

Key Evidence

  • [L4] Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. (10.1016/j.jhsa.2009.02.006)
  • [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. (10.1097/corr.0000000000003425)
  • [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. (10.1016/j.jhsa.2024.07.003)
  • [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. (10.1097/corr.0000000000002149)
  • [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. (10.1016/j.arthro.2017.02.020)
  • [L1] Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. (10.1016/j.jhsa.2018.06.009)
  • [L3] In addition to the elbow, focusing on the upper segments is essential in the management of LE. (10.1016/j.jse.2018.12.010)
  • [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. (10.1302/0301-620x.105b2.bjj-2022-0883.r1)
  • [L4] Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, but refractory cases may benefit from interventional therapies or surgical approaches. (10.5397/cise.2019.22.4.227)
  • [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. (10.1177/0363546517753385)
  • [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. (10.1097/corr.0000000000002058)
  • [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. (10.1177/0363546518783976)
  • [L5] The author argues that persistent tennis elbow symptoms have little prognostic value and suggests that surgical interventions should be considered discretionary, ensuring they outperform the natural history of disease and placebo interventions. (10.1097/corr.0000000000002254)
  • [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. (10.1007/s00167-005-0662-5)
  • [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. (10.1016/j.jse.2009.12.016)
  • [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. (10.1007/s11999-014-4022-y)
  • [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. (10.1016/j.arthro.2018.08.010)
  • [L3] Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET). (10.1016/j.jse.2025.10.006)
  • [L5] Surgeons should explore other innovative treatments that either actively improve pain relief in lateral elbow epicondylitis or accelerate the rate of soft tissue healing of these elbow lesions. (10.1097/corr.0000000000002876)
  • [L5] Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management. (10.1016/j.xrrt.2023.07.006)
  • [L1] Acute lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks. (10.1186/s12891-015-0582-6)
  • [L5] Physical examination of the elbow is a critical component in formulating an accurate diagnosis. (10.5435/jaaos-d-16-00622)
  • [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. (10.1302/2058-5241.1.000049)
  • [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. (10.1016/j.jhsa.2007.07.019)
  • [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. (10.3390/healthcare10061095)
  • [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. (10.1016/j.jse.2016.01.033)
  • [L4] To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. (10.1177/1558944716668844)
  • [L4] The majority of the top 50 cited articles in elbow arthroscopy comprised case series exhibiting Level IV or V evidence. (10.1016/j.jisako.2024.04.011)
  • [L5] Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections. (10.5435/00124635-200801000-00004)
  • [L5] The author recommends against using these injections in patients with lateral epicondylitis. (10.1097/corr.0000000000001249)
  • [L5] Elbow arthroscopy has become a safer and more effective treatment modality for several elbow pathologies due to advances in equipment and surgical technique. (10.5435/00124635-200810000-00003)
  • [L2] Both orthoses improved elbow proprioception, pain severity, and force production in the hand. (10.1016/j.jse.2018.08.042)
  • [L3] This study presents novel evidence of an adaptive motor pattern in lateral elbow tendinopathy, characterized by increased relative activation and coactivation of the anconeus muscle depending on grip force. (10.1016/j.jse.2024.11.001)
  • [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. (10.1177/0363546513504285)
  • [L4] Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. (10.1016/j.arthro.2012.04.109)
  • [L2] Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. (10.1016/j.arthro.2020.12.054)
  • [L5] Management ranges from simple analgesia and conservative therapies to surgical intervention for refractory cases. (10.1302/0301-620x.95b9.29285)
  • [L2] Magnetic resonance imaging is a reliable tool in determining radiological severity of lateral epicondylitis. (10.1016/j.jhsa.2010.11.040)
  • [L2] The counterforce brace provides significant reduction in the frequency and severity of pain in the short term (2-12 weeks), as well as overall elbow function at 26 weeks, compared with the placebo brace. (10.1016/j.jse.2018.10.002)
  • [L4] The clinical parameters of lateral epicondylitis may be influenced by several factors. (10.1186/s13018-021-02406-5)
  • [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. (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. (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. (10.1016/j.jseint.2021.11.017)
  • [L1] At best, all treatments provided only small pain relief while increasing the odds of adverse events. (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. (10.1016/j.jse.2007.07.003)
  • [L4] This draws into question the diagnostic and prognostic value of MRI imaging in lateral epicondylar tendinopathy, especially in older patients. (10.1177/17585732221146731)
  • [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. (10.1186/s12891-025-09026-8)
  • [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. (10.1016/j.jhsa.2010.10.005)
  • [L3] The clinical use of MRI in the management of patients with enthesopathy of the ECRB origin merits further study. (10.1016/j.jhsa.2009.02.023)
  • [L4] In the recovered and unrecovered groups, improvement of tendinopathy area was 60% versus 16%, indicating that postoperative MRI findings reflect clinical outcomes. (10.1016/j.arthro.2022.07.019)
  • [L4] Patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament. (10.1016/j.jse.2012.04.008)
  • [L1] Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis. (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. (10.1016/j.jse.2022.11.019)
  • [L4] Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. (10.1177/0363546515612758)
  • [L4] Although the risk of complications is similar regardless of technique, patients may be counseled that their risk of infectious complications may be slightly higher with open releases. (10.1016/j.arthro.2017.01.042)
  • [L4] The incidence of failure requiring revision surgery for lateral epicondylitis in the studied population is low (1.5%). (10.1016/j.jse.2016.10.022)
  • [L4] A slight limitation in range of motion is a possible undesired consequence of this intervention. (10.1007/s00167-017-4531-9)
  • [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. (10.1007/s11552-011-9318-8)
  • [L4] This repeatable open technique offers excellent results with a low rate of complications at a mean follow-up of 9.8 years. (10.1016/j.jse.2009.09.008)

See Also

  • Tennis Elbow

References

[1] Functional Outcome of Arthroscopic Extensor Carpi Radialis Brevis Tendon Release in Chronic Lateral Epicondylitis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.006

[2] Can Surgeons or Patients Predict the Likelihood of Improvement With Nonoperative Treatment of Chronic Tennis Elbow?. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003425

[4] Management of Lateral Epicondylosis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.003

[5] Editor’s Spotlight/Take 5: Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002149

[6] Editorial Commentary: Elbow Lateral Epicondylitis (Tennis Elbow) Surgery Works, but Is Not Often Indicated. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.02.020

[7] Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized, Double-Blinded Trial. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.009

[8] Comparison of scapular position and upper extremity muscle strength in patients with and without lateral epicondylalgia: a case-control study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.12.010

[9] Is it time to reconsider the indications for surgery in patients with tennis elbow?. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b2.bjj-2022-0883.r1

[10] Current Trends for Treating Lateral Epicondylitis. Clinics in Shoulder and Elbow. 2019. DOI: 10.5397/cise.2019.22.4.227

[11] Surgical Treatment of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546517753385

[13] Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000002058

[14] Lateral Epicondylitis “Placebo” Surgery Was Actually a Lateral Denervation Procedure: Letter to the Editor. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518783976

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[17] Arthroscopic tennis elbow release. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.12.016

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[19] Editorial Commentary: Dealer's Choice for Arthroscopic Versus Open Lateral Epicondylitis Release? It's Not That Simple. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.08.010

[20] Clinical diagnosis of lateral-sided elbow pain: predictors for recognizing a diagnosis other than tennis elbow. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.10.006

[21] CORR Insights®: In the Treatment of Lateral Epicondylitis by Percutaneous Perforation, Injectables Have No Added Value. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002876

[22] Failed surgical treatment for lateral epicondylitis: literature review and treatment considerations for successful outcomes. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2023.07.006

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[24] Comprehensive Review of the Elbow Physical Examination. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00622

[25] Lateral epicondylitis of the elbow. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.000049

[26] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE.

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[30] 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

[31] Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis. HAND. 2017. DOI: 10.1177/1558944716668844

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[38] The immediate sensorimotor effects of elbow orthoses in patients with lateral elbow tendinopathy: a prospective crossover study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.042

[39] Altered anconeus muscle activation characteristics during isometric gripping in individuals with lateral elbow tendinopathy compared with age- and sex-matched control. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.001

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[45] Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.002

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[52] Defining tennis elbow characteristics – The assessment of magnetic resonance imaging defined tendon pathology in an asymptomatic population. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221146731

[53] Impaired cervical proprioception in patients with lateral epicondylitis: a case-control study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09026-8

[54] Effect of Elbow and Forearm Position on Contact Pressure Between the Extensor Origin and the Lateral Side of the Capitellum. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.10.005

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