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

Updated Aug 2026
一幅手绘插图，描绘了一个无脸的人正在打网球反手球。
网球肘：前臂肌腱在外侧肘部附着处受到刺激。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到肘部外侧疼痛。该区域是前臂肌肉肌腱附着于骨骼的位置。不适感通常逐渐出现。活动时可能感觉为钝痛或刺痛。许多人描述为一种沿前臂向手腕方向放射的烧灼感。

疼痛通常在手臂对抗阻力使用时加重。简单的日常任务可能变得困难。您可能难以举起咖啡杯、转动门把手或握手。将手伸到背后扣内衣或塞衬衫下摆可能引发剧烈疼痛。即使手持较轻的物体（如手机或书籍），若保持时间过长也可能感到不适。

您可能注意到活动后疼痛加重。通常在早晨醒来时首次活动时疼痛加剧。休息后肘部僵硬很常见。有些人发现患侧卧位会加重疼痛。您可能醒来时感到不适或无法找到舒适的体位。

尽管存在这些症状，但好消息是：网球肘是一种自限性疾病。这意味着它倾向于随时间自行缓解。症状的半衰期为三至四个月。这意味着在此时间段内，您的疼痛严重程度通常会显著减轻。无论采用何种治疗，大多数网球肘病例在六个月内缓解。约90%未经治疗的网球肘患者在一年内实现症状缓解。

在此时间跨度内，康复概率保持相对稳定。无论您出现症状的时间长短，这一规律均适用。症状持续时间较长并不意味着不手术预后较差。您的身体可能正在自我修复，即使过程感觉缓慢。

然而，准确诊断很重要。近半数（46.5%）因肘部外侧疼痛就诊的患者被诊断为非肘部外侧肌腱病。肘部体格检查是制定准确诊断的关键组成部分。如果您的疼痛持续或加重，您的外科医生将对您进行评估，以确保正确识别病因。这确保您获得针对您具体情况的确切指导。

实际发生了什么

网球肘是肘部外侧肌腱的磨损性损伤。这些肌腱将前臂肌肉连接到肘部外侧的骨性突起上。这种情况也被称为肱骨外上髁炎。疼痛源于这些肌腱中的微小撕裂和炎症。

受累的主要肌腱附着于桡侧腕短伸肌。该肌肉有助于伸展手腕和手指。当你抓握物体或提起物品时，该肌腱承受很大的压力。随着时间的推移，反复的应力导致肌腱纤维磨损。身体难以足够快地修复这种损伤。这导致前臂和肘部疼痛和无力。

身体的自然愈合过程相当缓慢。网球肘症状的半衰期为三到四个月。这意味着即使不进行治疗，疼痛减半也需要那么长时间。大约 90% 未经治疗的网球肘患者在 1 年内实现了症状缓解。在一年的时间跨度内，无论既往症状持续时间如何，康复的概率保持相对恒定。

由于大多数病例可自行消退，因此并非总是需要手术。无论采用何种治疗，大多数病例在 6 个月内即可消退。大多数肱骨外上髁炎病例对适当的非手术治疗方案有反应。您的外科医生可能会从休息、物理治疗或支具固定开始。

与安慰剂支具相比，对抗力支具在短期内（2-12 周）显著降低了疼痛的频率和严重程度。与安慰剂支具相比，对抗力支具在 26 周时改善了整体肘部功能。这些保守措施为肌腱愈合提供了时间。

仅在这些方法失败时才考虑手术。持续性网球肘症状并非手术的良好指征，因为大多数患者无需手术即可实现症状缓解。外科医生无法可靠地预测哪些患者会对慢性网球肘的非手术治疗产生改善。对于少数对非手术治疗无反应的患者，手术满意度接近 90%。

关节镜下网球肘松解术的目标是去除受损组织。这允许健康组织重新生长。关节镜和开放外侧松解术是不同的，关节镜手术能够全面评估关节内肘部情况。关节镜下网球肘松解术为大多数肱骨外上髁炎患者提供了症状改善。

我们能做什么

在罗克汉普顿 Mater 私人医院，Kieran Hirpara 医生治疗网球肘时侧重于自然恢复。大多数病例可自行改善。约 90% 的患者在一年内症状缓解，即使未经治疗也是如此。该病的半衰期为三至四个月，意味着症状会随时间逐渐消退。我们通常建议从自我管理开始，并配合物理治疗。您可以尝试让手臂休息，并调整会引起疼痛的活动。物理治疗旨在增强前臂肌肉并提高灵活性。大多数患者通过这些标准的保守治疗在六个月内康复。

如果疼痛持续，我们可能会讨论药物治疗方案。这包括简单的止痛药和抗炎药物。注射是另一种选择，尽管证据表明它们只能提供轻微的止痛效果，并可能增加副作用的风险。富血小板血浆或自体血注射等治疗并不能减轻该病的疼痛或改善功能。皮质类固醇注射可提供短期缓解，但随着肌腱缓慢愈合，效果通常会消退。我们会清楚地解释这些选项，以便您选择最适合您的方案。

只有在经过合理期限的非手术治疗后改善不足时，才会考虑手术。持续性症状并非手术的良好指征，因为大多数患者无需手术即可缓解。我们无法可靠地预测哪些患者会对非手术治疗产生改善。如果需要手术，关节镜下网球肘松解术可为大多数患者带来症状改善。对于对非手术方法无反应的小部分患者，手术满意度接近 90%。我们将此视为共同决策，确保您在继续治疗前充分了解益处和风险。

预期情况

网球肘通常可自行好转。约 90% 的患者症状可在一年内缓解，即使未接受特异性治疗。愈合过程遵循稳定的规律。症状的半衰期为三至四个月，意味着症状会随时间逐渐消退。无论疼痛持续时间长短，这一时间线均适用。症状持续时间较长并不能预测较差的预后。大多数病例在六个月内缓解，无论采用何种方法。

由于身体通常能自然愈合，手术很少作为首选步骤。您的外科医生无法可靠地预测哪些患者会通过非手术治疗改善，哪些不会。因此，仅因非手术治疗失败并不是选择手术的充分理由。我们专注于在身体自我修复的过程中管理您的症状。持续性疼痛并非需要手术的可靠指标，因为大多数患者无需手术即可康复。

对于少数对非手术治疗无反应的患者，手术提供了一条明确的治疗途径。在这些情况下，您可获得近 90% 的满意度。手术干预被视为选择性治疗。仅当手术带来的益处超过自然愈合过程或安慰剂效应时，才应选择手术。当非手术治疗无效时，手术选项为那些持续疼痛的患者提供了高成功率。

并发症风险通常较低，且在不同手术技术间相似。需要翻修手术失败的发生率仅为 1.5%。术前注射三次或更多是翻修手术的最显著危险因素。开放式手术技术在长期随访中提供优异的结果和较低的并发症发生率。您可能会被告知，与其他方式相比，开放式松解术的感染并发症风险略高。

每个人的恢复感受各不相同。部分患者在短期康复期内功能显著改善。另一些患者可能会注意到活动范围轻微受限，或在关节镜手术后罕见地出现异位骨化（软组织内骨生长）。除了肘部，关注上臂上部对于全面管理至关重要。我们的目标是帮助您以最小的干扰和持久的缓解回归日常生活。

何时就诊

如果休息数周后肘部疼痛仍未改善，请咨询您的全科医生。大多数人在六个月内无需手术即可康复。即使不接受治疗，约90%的患者在一年内症状会缓解。无论疼痛持续时间长短，康复的可能性保持稳定。如果您注意到无力、不稳定或疼痛在夜间将您痛醒，请要求专科医生进行评估。突然加重也需要进行检查。您的外科医生将对您的肘部进行检查以确诊。这种体格检查至关重要，因为近一半患有外侧肘部疼痛的患者所患疾病并非网球肘。

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.

Evidence & references

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

Overview

  • Tennis elbow diagnosis and treatment concepts impact work participation [1].
  • About 90% of people with untreated tennis elbow achieve symptom resolution at 1 year [2].
  • Elbow arthroscopy is a safe modality of treatment for a variety of pathologies in experienced hands [4].
  • Numerous treatment options exist for epicondylitis, but no single universally accepted protocol has emerged [5].
  • Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management [7].
  • Refractory cases of lateral epicondylitis may benefit from interventional therapies or surgical approaches [7].
  • There is insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain due to small study numbers, large heterogeneity, small sample sizes, and poor outcome reporting [10].
  • 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 [11].
  • Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management [12].
  • There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow [14].
  • Most patients with lateral epicondylosis experience relief with non-operative management [16].
  • Controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases of lateral epicondylosis [16].
  • Surgical intervention for refractory medial epicondylitis often has a high success rate with patients generally demonstrating an improvement in patient-reported outcomes [24].
  • Patients with refractory medial epicondylitis have an encouraging number returning to work with limited complications after surgical intervention [24].
  • Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment, based on evidence with significant methodological limitations [26].

Anatomy & Pathophysiology

  • Tennis elbow is a degenerative disease [8].
  • The onset of tennis elbow is hastened by overuse of the arm and elbow [8].
  • Lateral epicondylitis is associated with combined physical exertion and elbow movements [3].
  • Biomechanical exposure involving wrist and/or elbow at work is associated with the incidence of lateral epicondylitis [34].
  • Repetitive exposure to bending or straightening the elbow is a significant risk factor for medial and lateral epicondylitis [48].
  • Self-reported physical exposures implicating repetitive and extensive/prolonged wrist bend/twisting and forearm movements are associated with incident cases of lateral and medial epicondylitis [50].
  • Hypoechogenicity and bone changes indicate the presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia [13].
  • Increased MRI signal in the extensor carpi radialis brevis (ECRB) origin is common in both symptomatic and asymptomatic elbows [31].
  • The common extensor tendon (CET) is thicker in men and in the dominant elbow [49].
  • There is no difference in CET thickness regarding age groups [49].
  • Lateral epicondylalgia is characterized by considerable terminological heterogeneity and a lack of clear, recognized diagnostic criteria [17].
  • Accurate diagnosis of medial epicondylitis requires distinguishing it from other elbow conditions [9].
  • Treatment of medial epicondylitis is guided by the specific pathologic stage of the tendon [9].
  • Persistent lateral elbow pain can result from overlooked posterolateral impingement of the elbow [22].
  • Understanding the static and dynamic anatomy of the lateral part of the elbow is necessary for developing future treatment and preventive strategies [22].
  • Arthroscopic tennis elbow release involves establishing a proximal medial or superomedial portal located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [42].
  • During arthroscopic tennis elbow release, the joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [42].
  • A 2.7-mm, 30-degree arthroscope is introduced into the joint through the proximal medial or superomedial portal, maintaining contact with the anterior aspect of the humerus [42].
  • A superolateral portal is established with an 18-gauge needle through the lesion to identify the undersurface of the extensor carpi radialis brevis tendon [42].
  • Pathologic tendinous attachment of the extensor carpi radialis brevis is debrided using a curet and motorized shaver, and the lateral epicondyle is decorticated [42].
  • Decortication of the lateral epicondyle and lateral epicondylar ridge can be performed with an arthroscopic burr, handheld instruments, or electrocautery [42].
  • A 70-degree arthroscope may be required in rare instances during arthroscopic tennis elbow release [42].
  • Heterotopic ossification (HO) can develop after elbow arthroscopy for lateral epicondylitis [15].

Classification

  • Tennis elbow is considered a degenerative disease [8].
  • There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP) [17].
  • There is a lack of clear and recognised diagnostic criteria for evaluating and treating patients with lateral elbow pain [17].
  • Persistent tennis elbow symptoms have little prognostic value [2].
  • No single universally accepted protocol has emerged for the treatment of epicondylitis [5].
  • There is little clear consensus on which modality works best for both conservative and operative options for lateral epicondylitis [29].
  • The understanding of the disease process of lateral epicondylitis is currently incomplete [29].
  • Failed surgical treatment of lateral epicondylitis is multifactorial [12].
  • Distinguishing the cause of failed surgical treatment of lateral epicondylitis is critical for appropriate management [12].

Clinical Presentation

  • Tennis elbow is a degenerative disease whose onset is hastened by overuse of the arm and elbow [8].
  • Lateral epicondylitis is a common, generally self-limiting tendinosis affecting patients aged 35 to 55 years [37].
  • Lateral elbow tendinosis is relatively common, particularly among individuals aged 40 to 49 years [20].
  • Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment [27].
  • Nonoperative treatment for lateral and medial epicondylitis in athletes has a success rate of up to 90% [28].
  • Lateral epicondylitis often resolves spontaneously, warranting considerable circumspection before embarking on treatment [18].
  • Work-related risk factors for lateral epicondylitis include combined physical exertion and elbow movements [3].
  • There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP), associated with a lack of clear and recognised diagnostic criteria [17].
  • The presence of hypoechogenicity and bone changes indicates a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia [13].

Investigations

  • Tennis elbow is a degenerative disease, the onset of which is hastened by overuse of the arm and elbow [8].
  • Combined physical exertion and elbow movements are strongly associated with lateral epicondylitis [3].
  • Accurate diagnosis requires distinguishing lateral epicondylitis from other elbow conditions [9].
  • Treatment is guided by the specific pathologic stage of the tendon in epicondylitis [9].
  • No single universally accepted protocol has emerged for the diagnosis and management of epicondylitis [5].
  • The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia [13].
  • There is evidence to support the use of ultrasound in the detection of lateral epicondylitis [52].
  • Routine use of MRI for the diagnosis of lateral epicondylitis is low [41].
  • Lateral epicondyle calcifications are much more common in lateral epicondylitis than previously reported, possibly owing to modern digital radiography and magnification [53].
  • Lateral epicondyle calcifications do not appear to be related to clinical factors including patient-reported measures [53].

Treatment

Natural History and Prognosis

  • Approximately 90% of people with untreated tennis elbow achieve symptom resolution at 1 year based on placebo or no-treatment control arms of randomized trials [2].
  • Lateral epicondylitis is a self-limited condition that usually resolves over a 12- to 18-month period without treatment [27].
  • Lateral epicondylitis has a self-limiting course of 12 to 18 months, with most patients well-managed with non-operative treatment and activity modification [35].
  • The prognosis for medial epicondylitis in occupational settings is good, with a 3-year recovery rate of 81% [19].

Non-Operative Management

  • Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections [38].
  • Most patients with tennis elbow experience relief with non-operative management [16].
  • Corticosteroid injections provide significant short-term benefits for tennis elbow, but these benefits are reversed after six weeks with high recurrence rates, implying the treatment should be used with caution [21].
  • Peri-articular hyaluronic acid (HA) treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing [36].
  • Normal saline (NS) injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis [39].
  • Local platelet-rich plasma (PRP) injections were associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroid treatment for lateral epicondylitis at a follow-up of 6 months [40].
  • Further investigations are needed regarding the effectiveness of eccentric exercise therapy for epicondylar tendinopathy [6].

Operative Management

  • Surgical intervention for refractory medial epicondylitis often has a high success rate, with patients generally demonstrating an improvement in patient-reported outcomes and an encouraging number returning to work with limited complications [24].
  • Surgical options for tennis elbow are reserved for recalcitrant cases [28].
  • There is insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain due to a small number of studies, large heterogeneity in interventions, small sample sizes, and poor reporting of outcomes [10].

Clinical Practice and Consensus

  • While numerous treatment options exist for epicondylitis, no single universally accepted protocol has emerged [5].
  • There is little clear consensus on which modality works best for both conservative and operative options for lateral epicondylitis, indicating that the understanding of the disease process is currently incomplete [29].
  • There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow in UK clinical practice [14].

Complications

  • Corticosteroid injection for tennis elbow provides significant short-term benefits but reverses after six weeks with high recurrence rates [21].
  • Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis but a negative effect in the intermediate term [25].
  • Heterotopic ossification (HO) has been reported as a complication following elbow arthroscopy for lateral epicondylitis [15].
  • Short-term complication rates appear comparable between open and arthroscopic surgical treatment for lateral epicondylitis [43].
  • Medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction in pitchers is associated with an increased risk for further surgical intervention [45].

Recovery

  • Enthesopathy of the extensor carpi radialis brevis origin is a benign, self-limiting disorder with a natural history of spontaneous resolution [33].
  • No treatments have been proven to alter the course of enthesopathy of the extensor carpi radialis brevis origin [33].
  • The prognosis for medial epicondylitis in occupational settings was good with a 3-year recovery rate at 81% [19].
  • Poor prognosis at 1 year of follow-up for lateral epicondylitis was related to manual work and high baseline pain [46].
  • No relation was found between the type of medical treatment given or chosen and prognosis for lateral epicondylitis at 1 year [46].
  • Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis [25].
  • Corticosteroid injections have a negative effect in the intermediate term for lateral epicondylitis [25].
  • The significant short-term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates [21].
  • Radial extracorporeal shock wave therapy (ESWT) was related to better effects in lateral epicondylitis [30].
  • Symptom duration of longer than 6 months was related to better effects with radial ESWT for lateral epicondylitis [30].
  • Short follow-up duration (less than 24 weeks) was related to better effects with radial ESWT for lateral epicondylitis [30].
  • Due to heterogeneity in studies regarding disorder duration, shock wave therapy type, frequency, dose, management type, control group, follow-up timing, and outcomes assessed, a pooled meta-analysis of shock wave therapy for lateral elbow tendinopathy was considered inappropriate [55].
  • Controversy remains regarding the optimal modality for quickest recovery in lateral epicondylosis [16].
  • Controversy remains regarding the role of surgical intervention for refractory cases of lateral epicondylosis [16].

Key Evidence

  • [L4] This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation. [1] (10.1177/1758573218797973)
  • [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. [2] (10.1097/corr.0000000000002058)
  • [L4] This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral epicondylitis. [3] (10.1002/ajim.22140)
  • [L4] In experienced hands, elbow arthroscopy is a safe modality of treatment for a variety of pathologies. [4] (10.1016/j.arthro.2007.03.080)
  • [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. [5] (10.1016/j.jhsa.2009.01.022)
  • [L2] Further investigations are needed, not only focused on shoulder impingement or epicondylar tendinopathy, but on tendinopathies in other areas of the upper limb. [6] (10.1016/j.jsams.2015.06.007)
  • [L4] Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, but refractory cases may benefit from interventional therapies or surgical approaches. [7] (10.5397/cise.2019.22.4.227)
  • [L4] The findings are consistent with the hypothesis that tennis elbow is a degenerative disease, the onset of which is hastened by overuse of the arm and elbow. [8] (10.1177/036354657900700405)
  • [L5] Accurate diagnosis requires distinguishing it from other elbow conditions, and treatment is guided by the specific pathologic stage of the tendon. [9] (10.1016/j.csm.2004.04.011)
  • [L1] Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain. [10] (10.1002/14651858.cd003525.pub2)
  • [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. [11] (10.1007/s11999-014-4022-y)
  • [L5] Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management. [12] (10.1016/j.xrrt.2023.07.006)
  • [L4] The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. [13] (10.1186/1471-2342-14-10)
  • [L4] There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow. [14] (10.1177/1758573217738199)
  • [L4] To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. [15] (10.1177/1558944716668844)
  • [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. [16] (10.1016/j.jhsa.2024.07.003)
  • [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. [17] (10.3390/healthcare10061095)
  • [L4] Overall, the available data suggest that lateral epicondylitis often resolves spontaneously, warranting considerable circumspection before embarking on treatment. [18] (10.1016/j.otsr.2019.09.004)
  • [L2] The prognosis for medial epicondylitis in this population was good with a 3-year recovery rate at 81%. [19] (10.1097/01.jom.0000085888.37273.d9)
  • [L3] The study indicates that lateral elbow tendinosis is relatively common, particularly among individuals aged 40 to 49 years. [20] (10.1177/0363546514568087)
  • [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. [21] (10.1136/bmj.38961.584653.ae)
  • [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. [22] (10.5397/cise.2023.01081)
  • [L4] Surgical intervention for refractory medial epicondylitis often has a high success rate with patients generally demonstrating an improvement in patient-reported outcomes and an encouraging number returning to work with limited complications. [24] (10.1177/03635465221095565)
  • [L1] Corticosteroid injections have a shortterm beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. [25] (10.1136/bmjopen-2013-003564)
  • [L1] Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. [26] (10.1177/1758573217745041)
  • [L2] Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment. [27] (10.1007/s11552-014-9642-x)
  • [Paper] The article reviews the pathology, clinical presentation, and treatment options for lateral and medial epicondylitis in athletes, noting that nonoperative treatment has a success rate of up to 90% and that surgical options are reserved for recalcitrant cases. [28] (10.1016/j.csm.2010.06.009)
  • [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. [29] (10.1016/j.jhsa.2007.07.019)
  • [L1] Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. [30] (10.1097/corr.0000000000001246)
  • [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. [31] (10.1016/j.jse.2016.01.033)
  • [L5] Enthesopathy of the extensor carpi radialis brevis origin is a benign, self-limiting disorder with a natural history of spontaneous resolution, for which no treatments have been proven to alter the course. [33] (10.5435/jaaos-d-15-00233)
  • [L2] The results of this meta-analysis strongly support the hypothesis of an association between biomechanical exposure involving wrist and/or elbow at work and incidence of lateral epicondylitis. [34] (10.1002/acr.22874)
  • [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. [35] (10.1302/2058-5241.1.000049)
  • [L1] Peri-articular HA treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing. [36] (10.1186/1758-2555-2-4)
  • [L5] Lateral epicondylitis is a common, generally self-limiting tendinosis affecting patients aged 35 to 55 years. [37] (10.1302/0301-620x.95b9.29285)
  • [L5] Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections. [38] (10.5435/00124635-200801000-00004)
  • [L1] NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. [39] (10.1177/0363546519899644)
  • [L1] Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months. [40] (10.1016/j.ijsu.2019.05.003)
  • [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. [41] (10.1016/j.jhsa.2023.03.025)
  • [L3] Surgical management of lateral epicondylitis varies depending on surgeons' fellowship training, and short-term complication rates appear comparable between open and arthroscopic treatment. [43] (10.1016/j.arthro.2017.04.078)
  • [L3] Those who experience medial elbow pain are at increased risk for further surgical intervention. [45] (10.1177/2325967118808782)
  • [L2] Poor prognosis at 1yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain, whilst no relation was found between the type of medical treatment given/chosen and prognosis. [46] (10.1093/rheumatology/keg360)
  • [L4] Repetitive exposure to bending/straightening the elbow was a significant risk factor for medial and lateral epicondylitis. [48] (10.1093/rheumatology/ker228)
  • [L3] This study presents the US characteristics and normal values of the CET, finding that the tendon was thicker in men and in the dominant elbow with no difference regarding age groups. [49] (10.1177/2325967117704186)
  • [L2] Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study. [50] (10.1136/oemed-2012-101341)
  • [L2] There is evidence to support the use of ultrasound in the detection of lateral epicondylitis. [52] (10.1016/j.otsr.2014.01.006)
  • [L4] Lateral epicondyle calcifications are much more common in lateral epicondylitis than previously reported, possibly owing to modern digital radiography and magnification, although they do not appear to be related to clinical factors including patient-reported measures. [53] (10.1016/j.jhsa.2017.03.016)
  • [L1] With current studies heterogeneous in terms of the duration of the disorder; type, frequency and total dose of SWT; period of time between SWT; type of management and control group; timing of follow-up and outcomes assessed, a pooled meta-analysis of SWT for lateral elbow tendinopathy was considered inappropriate. [55] (10.1093/bmb/ldm019)

References

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

[3] Work‐related risk factors for lateral epicondylitis and other cause of elbow pain in the working population. American Journal of Industrial Medicine. 2012. DOI: 10.1002/ajim.22140

[4] “Humero Radial Plica” Causing Lateral Elbow Pain, an Analysis of 117 Elbow Arthroscopies (SS‐66). Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.03.080

[5] Elbow Tendinopathy and Tendon Ruptures: Epicondylitis, Biceps and Triceps Ruptures. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.01.022

[6] Effectiveness of the eccentric exercise therapy in physically active adults with symptomatic shoulder impingement or lateral epicondylar tendinopathy: A systematic review. Journal of Science and Medicine in Sport. 2016. DOI: 10.1016/j.jsams.2015.06.007

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

[8] An epidemiologic study of tennis elbow. The American Journal of Sports Medicine. 1979. DOI: 10.1177/036354657900700405

[9] Diagnosis and treatment of medial epicondylitis of the elbow. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.04.011

[10] Surgery for lateral elbow pain. Cochrane Database of Systematic Reviews. 2011. DOI: 10.1002/14651858.cd003525.pub2

[11] Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-014-4022-y

[12] 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

[13] The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Medical Imaging. 2014. DOI: 10.1186/1471-2342-14-10

[14] Management of tennis elbow: a survey of UK clinical practice. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217738199

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

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

[17] Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews. Healthcare. 2022. DOI: 10.3390/healthcare10061095

[18] Management of lateral epicondylitis. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.09.004

[19] Medial Epicondylitis in Occupational Settings: Prevalence, Incidence and Associated Risk Factors. Journal of Occupational and Environmental Medicine. 2003. DOI: 10.1097/01.jom.0000085888.37273.d9

[20] The Epidemiology and Health Care Burden of Tennis Elbow. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546514568087

[21] 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

[22] Persistent lateral elbow pain from overlooked posterolateral impingement of the elbow: a literature review and guidance for treatment. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2023.01081

[24] Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A Systematic Review. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221095565

[25] Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open. 2013. DOI: 10.1136/bmjopen-2013-003564

[26] Surgery for tennis elbow: a systematic review. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217745041

[27] Non-Surgical Treatment of Lateral Epicondylitis: A Aystematic Review of Randomized Controlled Trials. HAND. 2014. DOI: 10.1007/s11552-014-9642-x

[28] Epicondylitis in the Athlete’s Elbow. Clinics in Sports Medicine. 2010. DOI: 10.1016/j.csm.2010.06.009

[29] Lateral Epicondylitis: Review and Current Concepts. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.07.019

[30] Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001246

[31] 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

[33] Enthesopathy of the Extensor Carpi Radialis Brevis Origin. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00233

[34] Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta‐Analysis. Arthritis Care & Research. 2016. DOI: 10.1002/acr.22874

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

[36] Management of Tennis Elbow with sodium hyaluronate periarticular injections. BMC Sports Science, Medicine and Rehabilitation. 2010. DOI: 10.1186/1758-2555-2-4

[37] Lateral epicondylitis. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b9.29285

[38] Management of Lateral Epicondylitis: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200801000-00004

[39] Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546519899644

[40] Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials. International Journal of Surgery. 2019. DOI: 10.1016/j.ijsu.2019.05.003

[41] The Use and Downstream Associations of Magnetic Resonance Imaging for Lateral Epicondylitis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.03.025

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

[43] Trends in Surgical Treatment of Lateral Epicondylitis Among Recently Trained Orthopaedic Surgeons. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.078

[45] Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118808782

[46] Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice. Rheumatology. 2003. DOI: 10.1093/rheumatology/keg360

[48] Occupation and epicondylitis: a population-based study. Rheumatology. 2011. DOI: 10.1093/rheumatology/ker228

[49] Ultrasonographic Characteristics of the Common Extensor Tendon of the Elbow in Asymptomatic Individuals: Thickness, Color Doppler Activity, and Bony Spurs. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117704186

[50] Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study: Table 1. Occupational and Environmental Medicine. 2013. DOI: 10.1136/oemed-2012-101341

[52] The diagnostic test accuracy of ultrasound for the detection of lateral epicondylitis: A systematic review and meta-analysis. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2014.01.006

[53] Radiographic and Clinical Analysis of Lateral Epicondylitis. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.016

[55] Repetitive shock wave therapy for lateral elbow tendinopathy (tennis elbow): a systematic and qualitative analysis. British Medical Bulletin. 2007. DOI: 10.1093/bmb/ldm019

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