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Tennis Elbow PDF Evidence

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

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

What you're feeling

You likely feel pain on the outside of your elbow. This area is where your forearm muscles connect to the bone. The discomfort often starts gradually. It may feel like a dull ache or a sharp sting. You might notice it more when you lift objects. Gripping things tightly can also trigger pain. Simple tasks like turning a doorknob or holding a coffee cup may become difficult.

The pain often flares up after activity. You might feel it increase during or right after using your arm. Reaching behind your back to fasten a bra can be painful. Tucking in your shirt may also hurt. Some people find that sleeping on the affected side disturbs their rest. The pain can sometimes travel down your forearm. It rarely goes past your wrist.

You may wonder if the pain will last forever. The good news is that tennis elbow is a self-limiting condition. This means it tends to resolve on its own over time. Symptoms have a steady half-life of three to four months. This means the intensity often drops significantly every few months. Most cases resolve by 6 months no matter what treatment is used. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year.

Your surgeon cannot reliably predict who will or will not improve with nonoperative treatment. However, longer symptom duration does not indicate a poorer prognosis without surgery. The probability of recovery remains fairly constant over the timespan regardless of prior symptom duration. Persistent symptoms are a poor indication for surgery as the majority of patients experience resolution without it.

If you do not respond to nonoperative approaches, surgery is an option. For the small percentage of patients who do not respond, surgery provides near 90% satisfaction rates. Surgical interventions may be performed with a high rate of success. However, surgery should be considered discretionary. It should only be pursued if it outperforms the natural history of the disease.

What's actually happening

Tennis elbow is a wear-and-tear injury to the tendons on the outside of your elbow. These tendons connect your forearm muscles to the bony bump on the outside of your elbow, called the lateral epicondyle. Think of these tendons as thick ropes that help you grip things and bend your wrist. When you repeatedly lift or twist objects, these ropes take a heavy load.

Over time, this stress causes tiny tears in the tendon fibers. Your body tries to heal them, but the repair process often falls behind the damage. The tissue becomes weak and painful. This is why you feel pain when you shake hands, turn a doorknob, or lift a coffee cup. The pain is your body’s signal that the tendon is struggling under pressure.

The problem is not just in the tendon itself. The way your arm moves also plays a role. Research shows that your shoulder muscles and upper back strength are essential for managing this condition. If your shoulder is weak or positioned poorly, your elbow has to work much harder. This extra strain makes the tendon pain worse. It is like asking one person to carry a heavy box while another person refuses to help.

Your surgeon will check how your elbow feels and moves to confirm the diagnosis. They may look at your neck and shoulder too, because issues there can affect how your elbow senses position and strength. Sometimes, imaging like an MRI shows changes in the tendon, even if you do not have pain. This means the tendon might look different on a scan, but it does not always mean it is the source of your current discomfort.

Most of the time, this condition gets better on its own. About 90% of people see their symptoms resolve within one year, even without surgery. The pain often follows a steady pattern, improving significantly every three to four months. This is why your surgeon will likely recommend rest, physical therapy, and bracing first. Surgery is only considered if these non-surgical steps do not help after a long period.

What we can do about it

Most cases of tennis elbow get better on their own or with simple care. About 90% of people see their symptoms resolve within one year, even without treatment. The pain tends to fade steadily, with a half-life of three to four months. This means your discomfort improves by half every few months. Your surgeon cannot reliably predict who will improve and who will not, so it is wise to give non-surgical methods a fair chance.

Start with rest and activity modification. Avoid movements that trigger pain, such as heavy gripping or repetitive wrist extension. Physical therapy aims to strengthen the forearm muscles and improve flexibility. This approach helps manage the condition for most patients. You should also consider that nonsurgical treatments like rest, physical therapy, and injections are the mainstay of care. While these methods provide small pain relief, they are generally safe and effective for the majority.

If pain persists, your surgeon may discuss medical options. These include pain medication and anti-inflammatories to manage discomfort. Injections, such as cortisone or hyaluronic acid, can reduce inflammation and pain for a limited time. Platelet-rich plasma (PRP) or autologous blood injections are also available, though evidence shows they do not necessarily reduce pain or improve function more than other treatments. It is important to note that MRI scans are not routinely used for diagnosis, as imaging findings often do not match symptoms. If conservative care fails, surgery is an option. Arthroscopic release provides symptomatic improvement in most patients, with near 90% satisfaction rates for those who do not respond to nonoperative approaches. Surgery is typically reserved for cases where symptoms persist despite adequate time and therapy.

What to expect

Tennis elbow is a common condition that often resolves on its own. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year. The probability of recovery remains fairly constant over time, regardless of how long you have had symptoms. Longer symptom duration does not indicate a poorer prognosis without surgery.

Symptoms of tennis elbow have a steady half-life of three to four months. This means your pain and stiffness tend to improve gradually over this period. Tennis elbow resolves by 6 months in most cases, no matter what treatment is used. About 3/4 of patients with acute lateral epicondylitis recover within 52 weeks.

Because most cases respond to appropriate nonoperative treatment, surgery is rarely the first step. Persistent tennis elbow symptoms are a poor indication for surgery because the majority of patients experience symptom resolution without it. Surgeons are unable to reliably predict which patients will or will not improve with nonoperative treatment. Failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified.

If you do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates. For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates. Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. Arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period.

The risk of complications is similar regardless of whether open or arthroscopic release techniques are used. Patients may be counseled that their risk of infectious complications may be slightly higher with open releases compared to other techniques. The incidence of failure requiring revision surgery for lateral epicondylitis is low (1.5%). Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis.

Open surgical techniques for lateral epicondylitis offer excellent results with a low rate of complications at a mean follow-up of 9.8 years. However, controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases. Your surgeon will help you decide if surgery is right for you based on your specific situation.

When to see someone

See your GP if your elbow pain does not improve with rest. Most people recover within six months without surgery. About 90% of people see symptoms resolve by one year, even without treatment. Your recovery chance stays steady regardless of how long you have had pain. Symptoms often fade with a steady half-life of three to four months. Seek specialist review if you feel weakness, instability, or locking. Ask for help if pain interferes with sleep or work. Sudden worsening also warrants a check-up. Physical examination helps confirm the cause. Persistent pain alone is rarely enough to justify surgery. Most cases resolve on their own.

Reviewed by Dr Kieran Hirpara · 2026-06-10 20:08:51.998611+00:00.

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

title: "Tennis Elbow" slug: tennis-elbow region: elbow audience: patient mesh_terms: ["Tennis Elbow", "Elbow Joint", "Elbow", "Tendinopathy", "Tennis", "Elbow Injuries", "Pain Measurement", "Pain"] article_count: 318 model_used: Qwen3.6-35B-A3B-Q8_0.gguf generated_at: '2026-06-21T12:19:42+00:00' key_articles: - title: "Management of tennis elbow" ref_num: 1 evidence_tier: paper evidence_level: 1 doi: 10.2147/oajsm.s10310 year: 2011 - title: "Editorial Commentary: Elbow Lateral Epicondylitis (Tennis Elbow) Surgery Works, but Is Not Often Indicated" ref_num: 2 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2017.02.020 year: 2017 - title: "Stop injecting corticosteroid into patients with tennis elbow, they are much more likely to get better by themselves!" ref_num: 4 evidence_tier: paper doi: 10.1016/j.jsams.2009.09.009 year: 2010 - title: "Is it time to reconsider the indications for surgery in patients with tennis elbow?" ref_num: 5 evidence_tier: paper evidence_level: 4 doi: 10.1302/0301-620x.105b2.bjj-2022-0883.r1 year: 2023 - title: "Can Surgeons or Patients Predict the Likelihood of Improvement With Nonoperative Treatment of Chronic Tennis Elbow?" ref_num: 6 evidence_tier: paper evidence_level: 2 doi: 10.1097/corr.0000000000003425 year: 2025 - title: "Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis" ref_num: 7 evidence_tier: paper evidence_level: 1 doi: 10.1097/corr.0000000000002058 year: 2021 - title: "Editor’s Spotlight/Take 5: Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis" ref_num: 8 evidence_tier: paper evidence_level: 1 doi: 10.1097/corr.0000000000002149 year: 2022 - title: "Work‐related risk factors for lateral epicondylitis and other cause of elbow pain in the working population" ref_num: 9 evidence_tier: paper evidence_level: 4 doi: 10.1002/ajim.22140 year: 2012 - title: "Comprehensive Review of the Elbow Physical Examination" ref_num: 10 evidence_tier: paper evidence_level: 5 doi: 10.5435/jaaos-d-16-00622 year: 2018 - title: "CORR Insights®: Can Surgeons or Patients Predict the Likelihood of Improvement With Nonoperative Treatment of Chronic Tennis Elbow?" ref_num: 11 evidence_tier: paper doi: 10.1097/corr.0000000000003488 year: 2025 - title: "Natural course in tennis elbow—lateral epicondylitis after all?" ref_num: 12 evidence_tier: paper evidence_level: 4 doi: 10.1007/s00167-012-1939-0 year: 2012 - title: "Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study" ref_num: 13 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2014.07.017 year: 2015 - title: "Autologous Tenocyte Injection for the Treatment of Severe, Chronic Resistant Lateral Epicondylitis" ref_num: 14 evidence_tier: paper evidence_level: 4 doi: 10.1177/0363546513504285 year: 2013 - title: "Clinical diagnosis of lateral-sided elbow pain: predictors for recognizing a diagnosis other than tennis elbow" ref_num: 15 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jse.2025.10.006 year: 2026 - title: "Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy" ref_num: 18 evidence_tier: paper evidence_level: 4 doi: 10.1177/0363546515612758 year: 2015 - title: "Pediatric Sports Elbow Injuries" ref_num: 20 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.csm.2010.06.010 year: 2010 - title: "Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews" ref_num: 21 evidence_tier: paper evidence_level: 1 doi: 10.3390/healthcare10061095 year: 2022 - title: "Arthroscopic tennis elbow release" ref_num: 22 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2009.12.016 year: 2010 - title: "A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension" ref_num: 24 evidence_tier: paper evidence_level: 4 doi: 10.1002/ksa.12016 year: 2024 - title: "Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy" ref_num: 25 evidence_tier: paper evidence_level: 4 doi: 10.1186/s12891-022-05758-z year: 2022 - title: "Elbow stiffness: Arthritis and heterotopic ossification" ref_num: 26 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jisako.2023.10.009 year: 2024 - title: "Surgery for tennis elbow: a systematic review" ref_num: 27 evidence_tier: paper evidence_level: 1 doi: 10.1177/1758573217745041 year: 2017 - title: "Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players" ref_num: 30 evidence_tier: paper evidence_level: 2 doi: 10.1016/j.jse.2014.06.044 year: 2014 - title: "Persistent lateral elbow pain from overlooked posterolateral impingement of the elbow: a literature review and guidance for treatment" ref_num: 31 evidence_tier: paper evidence_level: 4 doi: 10.5397/cise.2023.01081 year: 2024 - title: "Ultrasound Examination Techniques for Elbow Injuries in Overhead Athletes" ref_num: 32 evidence_tier: paper evidence_level: 5 doi: 10.5435/jaaos-d-20-00935 year: 2020 - title: "Treatment of chronically dislocated elbows: A report of three cases" ref_num: 33 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2006.09.003 year: 2007 - title: "Current Concepts Review - Tendinosis of the Elbow (Tennis Elbow). Clinical Features and Findings of Histological, Immunohistochemical, and Electron Microscopy Studies*" ref_num: 34 evidence_tier: paper evidence_level: 5 doi: 10.2106/00004623-199902000-00014 year: 1999 - title: "First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow)" ref_num: 35 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2018.09.007 year: 2019 - title: "A Retrospective Comparison of the Management of Recalcitrant Lateral Elbow Tendinosis: Platelet-Rich Plasma Injections versus Surgery" ref_num: 36 evidence_tier: paper evidence_level: 3 doi: 10.1007/s11552-014-9717-8 year: 2014 - title: "Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use" ref_num: 37 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2017.12.027 year: 2018 - title: "Revision Ulnar Collateral Ligament Reconstruction Using a Suspension Button Fixation Technique" ref_num: 38 evidence_tier: paper evidence_level: 5 doi: 10.1177/0363546509350109 year: 2009 - title: "The Boyd–McLeod procedure for tennis elbow: mid- to long-term results" ref_num: 40 evidence_tier: paper evidence_level: 4 doi: 10.1177/1758573214540637 year: 2014 - title: "Current Trends for Treating Lateral Epicondylitis" ref_num: 41 evidence_tier: paper evidence_level: 4 doi: 10.5397/cise.2019.22.4.227 year: 2019 - title: "The spin move to facilitate antegrade coronoid fixation in terrible triad injuries" ref_num: 43 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jse.2022.11.020 year: 2023 - title: "Management of tennis elbow: a survey of UK clinical practice" ref_num: 45 evidence_tier: paper evidence_level: 4 doi: 10.1177/1758573217738199 year: 2017 - title: "Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?" ref_num: 46 evidence_tier: paper evidence_level: 4 doi: 10.1097/corr.0000000000002159 year: 2022 - title: "Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment" ref_num: 47 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2004.07.011 year: 2005 - title: "Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial" ref_num: 48 evidence_tier: paper evidence_level: 1 doi: 10.1136/bmj.38961.584653.ae year: 2006 - title: "The detection of the capsular tear at the undersurface of the extensor carpi radialis brevis tendon in chronic tennis elbow: the value of magnetic resonance imaging and computed tomography arthrography" ref_num: 50 evidence_tier: paper evidence_level: 2 doi: 10.1016/j.jse.2010.12.002 year: 2011 - title: "Lateral Elbow Tendinopathy: A Better Term Than Lateral Epicondylitis or Tennis Elbow" ref_num: 52 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2009.06.024 year: 2009 - title: "Traumatic Elbow Instability" ref_num: 53 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2010.05.002 year: 2010 - title: "Incidental magnetic resonance imaging signal changes in the extensor carpi radialis brevis origin are more common with age" ref_num: 54 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2016.01.033 year: 2016 - title: "Elbow Arthroscopy" ref_num: 55 evidence_tier: paper evidence_level: 5 doi: 10.5435/00124635-200810000-00003 year: 2008 - title: "Effects of Contralateral Trunk Tilt on Shoulder and Elbow Injury Risk and Pitching Biomechanics in Professional Baseball Pitchers" ref_num: 56 evidence_tier: paper evidence_level: 3 doi: 10.1177/03635465231151940 year: 2023 - title: "Postoperative Elbow Instability: Options for Revision Stabilization" ref_num: 57 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jhsa.2023.10.015 year: 2024 - title: "The coronoid opening angle: a novel radiographic technique to assess bone loss in coronoid trauma" ref_num: 58 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2021.12.039 year: 2022 - title: "The objective diagnosis of early tennis elbow by magnetic resonance imaging" ref_num: 60 evidence_tier: paper evidence_level: 4 doi: 10.1093/occmed/kqg031 year: 2003 - title: "Magnetic Resonance Imaging Findings After Elbow Dislocation: A Descriptive Study" ref_num: 61 evidence_tier: paper evidence_level: 4 doi: 10.1177/1558944720949961 year: 2020 - title: "Defining tennis elbow characteristics – The assessment of magnetic resonance imaging defined tendon pathology in an asymptomatic population" ref_num: 62 evidence_tier: paper evidence_level: 4 doi: 10.1177/17585732221146731 year: 2022 - title: "Post-traumatic osteoarthritis of the elbow" ref_num: 63 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.otsr.2013.11.004 year: 2014 - title: "Evidence for the Durability of Autologous Tenocyte Injection for Treatment of Chronic Resistant Lateral Epicondylitis" ref_num: 64 evidence_tier: paper evidence_level: 4 doi: 10.1177/0363546515579185 year: 2015 - title: "Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow" ref_num: 65 evidence_tier: paper evidence_level: 4 doi: 10.1136/bjsm.2007.043901 year: 2008 - title: "Lateral Elbow Tendinopathy" ref_num: 66 evidence_tier: paper evidence_level: 2 doi: 10.1177/0363546509359066 year: 2010 - title: "The Predictive Value of Diagnostic Sonography for the Effectiveness of Conservative Treatment of Tennis Elbow" ref_num: 68 evidence_tier: paper evidence_level: 1 doi: 10.2214/ajr.04.0656 year: 2005 - title: "Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report" ref_num: 69 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2012.04.008 year: 2012 - title: "Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study" ref_num: 70 evidence_tier: paper evidence_level: 1 doi: 10.1136/bjsm.2007.042762 year: 2008 synthesis_version: "v2" verifier_status: skipped

Overview

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

Anatomy & Pathophysiology

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

Classification

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

Clinical Presentation

  • Tennis elbow is a common problem [2].
  • Symptoms of tennis elbow have a steady half-life of three to four months [5].
  • Approximately 90% of people with untreated tennis elbow achieve symptom resolution at 1 year [7].
  • Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year, and the probability of recovery remained fairly constant over that timespan regardless of prior symptom duration [8].
  • Over 90% of patients with persistent tennis elbow symptoms experienced improvement without surgery [11].
  • The transient symptoms of tennis elbow reflect the natural course of a self-limiting condition [12].
  • Persistent tennis elbow symptoms have little prognostic value for predicting non-recovery [5].
  • Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it [6].
  • Longer symptom duration does not indicate a poorer prognosis without surgery [5].
  • Failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [5].
  • Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment [6].
  • Patients are unable to reliably predict who will or will not improve with nonoperative treatment [6].
  • The concept that surgery is indicated if symptoms persist for an arbitrary duration is undermined by the constant probability of recovery over time [8].
  • Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET) [15].
  • Physical examination of the elbow is a critical component in formulating an accurate diagnosis [10].
  • There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP) [21].
  • There is a lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain [21].
  • Tennis elbow is characterized by stenosing changes in the orbicular ligament and tendinitis of the common extensor origin [17].
  • Tennis elbow is a degenerative process characterized by angiofibroblastic hyperplasia rather than an inflammatory condition [34].
  • Combined physical exertion and elbow movements are strongly associated with lateral epicondylitis [9].

Investigations

  • Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET) [15].
  • The proposed MRI classification is one of the most reliable methods to define stages of chronic lateral epicondylitis [25].
  • MRI is an important decision-making tool in the surgical treatment of refractory tennis elbow [47].
  • Computed tomography arthrography (CTA) is a reliable and accurate diagnostic modality compared with MRI to detect capsular tears in patients with chronic tennis elbow [50].
  • Increased MRI signal in the extensor carpi radialis brevis (ECRB) origin is common in both symptomatic and asymptomatic elbows [54].
  • The coronoid opening angle can be of value alongside 3-dimensional imaging in evaluating elbow injuries and used as an adjunct in clinical decision making [58].
  • Oedema is commonly found in asymptomatic elbows, necessitating the presence of thickening or tears in the common extensor origin (CEO) tendon to objectively diagnose tennis elbow on MRI [60].
  • There should be an emphasis on not overanalyzing and treating based on MRI findings alone for young patients with elbow dislocations [61].
  • The diagnostic and prognostic value of MRI imaging in lateral epicondylar tendinopathy is called into question, especially in older patients [62].
  • Post-traumatic osteoarthritis of the elbow is an uncommon condition where clinical manifestations often vary from radiological findings [63].
  • Autologous tenocyte injection significantly improved clinical function and MRI tendinopathy scores for up to 5 years in patients with chronic resistant lateral epicondylitis who had previously undergone unsuccessful nonsurgical treatment [64].
  • The lack of both neovascularity and grey scale changes on ultrasound examination substantially increases the probability that lateral elbow tendinopathy is not present and should prompt consideration of other causes for lateral elbow pain [65].
  • The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity and indicate those who may not respond to nonoperative therapy [66].
  • Sonography has no prognostic value for predicting the effectiveness of brace only, physical therapy only, or a combination of these strategies in patients with tennis elbow [68].
  • Patients with chronic lateral epicondylitis who sustain an acute injury may develop an additional lesion involving the radial ulno-humeral ligament [69].
  • Ultrasound (US) and color Doppler (CD) guided intratendinous injections gave pain relief in patients with tennis elbow [70].

Treatment

Natural History and Non-Operative Management

  • There is no true consensus on the most efficacious management of tennis elbow, especially regarding effective long-term outcomes [1].
  • Tennis elbow resolves by 6 months in most cases regardless of the treatment used [2].
  • Symptoms of tennis elbow have a steady half-life of three to four months [5].
  • Longer symptom duration does not indicate a poorer prognosis without surgery [5].
  • Failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [5].
  • Persistent tennis elbow symptoms are a poor indication for surgery because the majority of patients experience symptom resolution without it [6].
  • Surgeons are unable to reliably predict which patients will or will not improve with nonoperative treatment [6].
  • About 90% of people with untreated tennis elbow achieve symptom resolution at 1 year based on placebo or no-treatment control arms of randomized trials [7].
  • Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management [41].
  • Corticosteroid injections for tennis elbow worsen the long-term outcomes of patients [4].

Operative and Interventional Management

  • For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates [2].
  • When nonoperative treatment is unsuccessful, surgical interventions may be performed with a high rate of success [22].
  • Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols, but refractory cases may benefit from interventional therapies or surgical approaches [41].
  • Percutaneous ultrasonic tenotomy is a safe and effective treatment for chronic medial and lateral elbow tendinosis, producing statistically significant improvements in pain and function over a 1-year follow-up period [13].
  • Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up [18].
  • Autologous tenocyte injection (ATI) showed significantly improved clinical function and structural repair at the origin of the common extensor tendon in patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of nonoperative treatment [14].
  • Injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma (STR/PRP) is a safe treatment that effectively induces clinically significant improvements in elbow symptoms, general well-being, objective measures of strength, and imaging of the common extensor tendon within 6 months for elbow tendinopathy recalcitrant to standard treatments [35].
  • Similar outcomes in pain improvement and return to work may be achievable with either platelet-rich plasma (PRP) injections or surgery in recalcitrant lateral elbow tendinosis [36].
  • A large percentage of patients who fail conservative treatment for medial humeral epicondylitis (tendinosis) can obtain pain relief and return to activities with the described operative technique [44].
  • Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment, based on evidence with significant methodological limitations [27].
  • There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow [45].

Complications

  • Corticosteroid injections for tennis elbow worsen long-term outcomes [4].
  • Corticosteroid injection provides significant short-term benefits that are reversed after six weeks, with high recurrence rates [48].
  • Persistent tennis elbow symptoms have little prognostic value, with approximately 90% of people with untreated tennis elbow achieving symptom resolution at 1 year [7].
  • Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year, and the probability of recovery remained fairly constant over that timespan regardless of prior symptom duration [8].
  • Over 90% of patients with persistent tennis elbow symptoms experienced improvement without surgery [11].
  • Tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment is used [2].
  • Symptoms of tennis elbow have a steady half-life of three to four months [5].
  • The transient symptoms of tennis elbow reflect the natural course of a self-limiting condition [12].
  • Conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union in male junior tennis players with medial epicondylar fragmentation, but elbow pain persisted in 50% of subjects at re-examination [30].

Recovery

  • Tennis elbow resolves by 6 months in most cases regardless of the treatment used [2].
  • Symptoms of tennis elbow have a steady half-life of three to four months [5].
  • Longer symptom duration does not indicate a poorer prognosis without surgery [5].
  • Failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified [5].
  • Persistent tennis elbow symptoms are a poor indication for surgery because the majority of patients experience symptom resolution without it [6].
  • Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment [6].
  • About 90% of people with untreated tennis elbow achieve symptom resolution at 1 year based on placebo or no-treatment control arms of randomized trials [7].
  • Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year [8].
  • The probability of recovery remained fairly constant over that timespan regardless of prior symptom duration [8].
  • The concept that surgery is indicated if symptoms persist for an arbitrary duration is undermined by the constant probability of recovery [8].
  • Over 90% of patients with persistent tennis elbow symptoms experienced improvement without surgery [11].
  • Conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union in male junior tennis players with medial epicondylar fragmentation of the humerus [30].
  • Elbow pain persisted in 50% of subjects with medial epicondylar fragmentation at re-examination despite spontaneous bone union [30].
  • Percutaneous ultrasonic tenotomy is a safe and effective treatment for chronic medial and lateral elbow tendinosis, producing statistically significant improvements in pain and function over a 1-year follow-up period [13].
  • Patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of nonoperative treatment showed significantly improved clinical function and structural repair at the origin of the common extensor tendon after autologous tenocyte injection (ATI) [14].
  • Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up [18].
  • Corticosteroid injections for tennis elbow worsen the long term outcomes of patients [4].

Key Evidence

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

References

[1] Management of tennis elbow. Open Access Journal of Sports Medicine. 2011. DOI: 10.2147/oajsm.s10310 [2] Editorial Commentary: Elbow Lateral Epicondylitis (Tennis Elbow) Surgery Works, but Is Not Often Indicated. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.02.020 [4] Stop injecting corticosteroid into patients with tennis elbow, they are much more likely to get better by themselves!. Journal of Science and Medicine in Sport. 2010. DOI: 10.1016/j.jsams.2009.09.009 [5] 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 [6] 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 [7] Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000002058 [8] 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 [9] 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 [10] Comprehensive Review of the Elbow Physical Examination. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00622 [11] CORR Insights®: 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.0000000000003488 [12] Natural course in tennis elbow—lateral epicondylitis after all?. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-1939-0 [13] Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.07.017 [14] Autologous Tenocyte Injection for the Treatment of Severe, Chronic Resistant Lateral Epicondylitis. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513504285 [15] 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 [17] Surgical Treatment of Tennis Elbow: A FOLLOW-UP STUDY.. The Journal of Bone and Joint Surgery. American Volume. 1965. [18] Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515612758 [20] Pediatric Sports Elbow Injuries. Clinics in Sports Medicine. 2010. DOI: 10.1016/j.csm.2010.06.010 [21] Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews. Healthcare. 2022. DOI: 10.3390/healthcare10061095 [22] Arthroscopic tennis elbow release. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.12.016 [24] A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12016 [25] Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05758-z [26] Elbow stiffness: Arthritis and heterotopic ossification. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.10.009 [27] Surgery for tennis elbow: a systematic review. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217745041 [30] Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.06.044 [31] 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 [32] Ultrasound Examination Techniques for Elbow Injuries in Overhead Athletes. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00935 [33] Treatment of chronically dislocated elbows: A report of three cases. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.003 [34] Current Concepts Review - Tendinosis of the Elbow (Tennis Elbow). Clinical Features and Findings of Histological, Immunohistochemical, and Electron Microscopy Studies. The Journal of Bone & Joint Surgery. 1999. DOI: 10.2106/00004623-199902000-00014 [35] First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow). Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.09.007 [36] A Retrospective Comparison of the Management of Recalcitrant Lateral Elbow Tendinosis: Platelet-Rich Plasma Injections versus Surgery. HAND. 2014. DOI: 10.1007/s11552-014-9717-8 [37] Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.12.027 [38] Revision Ulnar Collateral Ligament Reconstruction Using a Suspension Button Fixation Technique. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509350109 [40] The Boyd–McLeod procedure for tennis elbow: mid- to long-term results. Shoulder & Elbow. 2014. DOI: 10.1177/1758573214540637 [41] Current Trends for Treating Lateral Epicondylitis. Clinics in Shoulder and Elbow. 2019. DOI: 10.5397/cise.2019.22.4.227 [43] The spin move to facilitate antegrade coronoid fixation in terrible triad injuries. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.11.020 [44] 10.1177-036354659502300215. n.d.. [45] Management of tennis elbow: a survey of UK clinical practice. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217738199 [46] Does an Internal Joint Stabilizer and Standardized Protocol Prevent Recurrent Instability in Complex Persistent Elbow Instability?. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002159 [47] Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment. Journal of Shoulder and Elbow Surgery. 2005. DOI: 10.1016/j.jse.2004.07.011 [48] Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006. DOI: 10.1136/bmj.38961.584653.ae [50] The detection of the capsular tear at the undersurface of the extensor carpi radialis brevis tendon in chronic tennis elbow: the value of magnetic resonance imaging and computed tomography arthrography. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.12.002 [52] Lateral Elbow Tendinopathy: A Better Term Than Lateral Epicondylitis or Tennis Elbow. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.024 [53] Traumatic Elbow Instability. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.002 [54] Incidental magnetic resonance imaging signal changes in the extensor carpi radialis brevis origin are more common with age. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.01.033 [55] Elbow Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200810000-00003 [56] Effects of Contralateral Trunk Tilt on Shoulder and Elbow Injury Risk and Pitching Biomechanics in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231151940 [57] Postoperative Elbow Instability: Options for Revision Stabilization. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.10.015 [58] The coronoid opening angle: a novel radiographic technique to assess bone loss in coronoid trauma. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.12.039 [59] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE. [60] The objective diagnosis of early tennis elbow by magnetic resonance imaging. Occupational Medicine. 2003. DOI: 10.1093/occmed/kqg031 [61] Magnetic Resonance Imaging Findings After Elbow Dislocation: A Descriptive Study. HAND. 2020. DOI: 10.1177/1558944720949961 [62] Defining tennis elbow characteristics – The assessment of magnetic resonance imaging defined tendon pathology in an asymptomatic population. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221146731 [63] Post-traumatic osteoarthritis of the elbow. Orthopaedics & Traumatology: Surgery & Research. 2014. DOI: 10.1016/j.otsr.2013.11.004 [64] Evidence for the Durability of Autologous Tenocyte Injection for Treatment of Chronic Resistant Lateral Epicondylitis. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515579185 [65] Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow. British Journal of Sports Medicine. 2008. DOI: 10.1136/bjsm.2007.043901 [66] Lateral Elbow Tendinopathy. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546509359066 [68] The Predictive Value of Diagnostic Sonography for the Effectiveness of Conservative Treatment of Tennis Elbow. American Journal of Roentgenology. 2005. DOI: 10.2214/ajr.04.0656 [69] Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.04.008 [70] Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study. British Journal of Sports Medicine*. 2008. DOI: 10.1136/bjsm.2007.042762

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

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

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

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

Section 2 -- Scope.

a. License grant.

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

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

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

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

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

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

5. Downstream recipients.

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

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

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

b. Other rights.

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

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

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

Section 3 -- License Conditions.

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

a. Attribution.

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

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

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

ii. a copyright notice;

iii. a notice that refers to this Public License;

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

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

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

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

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

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

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

Section 4 -- Sui Generis Database Rights.

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

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

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

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

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

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

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

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

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

Section 6 -- Term and Termination.

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

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

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

2. upon express reinstatement by the Licensor.

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

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

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

Section 7 -- Other Terms and Conditions.

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

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

Section 8 -- Interpretation.

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

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

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

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

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

Creative Commons may be contacted at creativecommons.org.