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Tennis elbow release

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

79 citationsUpdated Oct 2026
Illustration: Tennis elbow release

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

Overview

Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis [1], achieving pain relief and restoration of elbow function [2]. However, surgical intervention is reserved for the small percentage of patients who do not respond to nonoperative approaches, as most cases resolve spontaneously or with standard conservative management [7, 10, 14]. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year [12, 13], and the probability of recovery remains fairly constant over a 1-year timespan regardless of prior symptom duration [12]. Consequently, persistent symptoms are a poor indication for surgery [4], and failed nonoperative treatment should not be used as an indication unless reliable predictors of non-recovery are identified [5].

The natural history of tennis elbow involves a steady half-life of three to four months [5], with symptoms resolving by 6 months in most cases no matter what treatment is used [9]. Longer symptom duration does not indicate a poorer prognosis without surgery [5], and surgeons are unable to reliably predict who will or will not improve with nonoperative treatment [4]. While controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases [7], surgery provides near 90% satisfaction rates for those who do not respond to nonoperative approaches [9]. Refractory cases may benefit from interventional therapies or surgical approaches [14], though a prospective, randomized, double-blinded, placebo-controlled clinical trial failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery [11].

Arthroscopic and open lateral release procedures are not the same [23]. The arthroscopic procedure offers the advantage of fully assessing the elbow intra-articularly and using less appealing portal-site incisions [23]. Clinical outcome scores show improvement after arthroscopic extensor carpi radialis brevis release for refractory lateral epicondylitis [40]. The Nirschl procedure and arthroscopic extensor carpi radialis brevis débridement are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy [36]. Radial nerve release, in association with surgical treatment, was not associated with greater improvement [3]. Other procedures, such as denervation of the lateral humeral epicondyle, have success rates of 75% to 80% [18], and minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement at 3-year follow-up [38]. Pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment compared with observation only or placebo [26].

Anatomy & Pathophysiology

Etiology and Pathology

Lateral epicondylitis occurs more frequently than medial epicondylitis, with reported ratios ranging from 4:1 to 7:1 [15]. The condition results from tendinous microtearing followed by an incomplete reparative response [15]. The anatomic basis for injury at the extensor carpi radialis brevis origin involves hypovascular zones, eccentric tendon stresses, and a microscopic degenerative response [20]. Pathologic tissue studies identify a failed reparative process rather than active inflammation [20]. Histologic evidence indicates that lateral epicondylitis arises from a failure of the inflammatory reparative mechanism of the extensor carpi radialis brevis due to overuse and repetitive stress activities [63]. Lateral elbow tendinopathy is characterized by disorganized collagen, an increased presence of fibroblasts, and the absence of prostaglandins and inflammatory cells [99]. Consequently, lateral elbow tendinopathy is a degenerative condition involving a failed healing tendon response rather than an inflammatory process [99]. The precise pathophysiology of lateral epicondylitis remains not completely understood [63].

Biomechanics and Physiology

Contact pressure between the bone and tendon at the origin of the common extensor tendons increases significantly with elbow extension, forearm pronation, and varus stress to the elbow under tension of the extensor tendons [70]. In patients with lateral elbow tendinopathy, wrist extension strength at 0 and 90 degrees is similar [108]. Altered anconeus muscle activation characteristics occur during isometric gripping in individuals with lateral elbow tendinopathy compared with age- and sex-matched controls [97]. Increased MRI signal in the extensor carpi radialis brevis origin is common in both symptomatic and asymptomatic elbows [65].

Diagnosis and Terminology

Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy [27]. Misdiagnosis can occur in patients affected by longstanding lateral elbow pain [39]. Considerable terminological heterogeneity exists in the description of lateral elbow pain, associated with the lack of clear and recognised diagnostic criteria [41]. Lateral elbow tendinopathy is considered the most appropriate term for clinical practice because other terms reference inappropriate etiologic, anatomic, and pathophysiologic concepts [99]. Physical examination of the elbow is a critical component in formulating an accurate diagnosis [53]. Magnetic resonance imaging is a reliable tool in determining radiological severity of lateral epicondylitis [43]. Clinical parameters of lateral epicondylitis may be influenced by several factors [109].

Associated Findings

Proprioception seems to be poorer in elbows with lateral epicondylitis than in the controls' elbows [116]. Patients with lateral epicondylitis exhibit significant cervical proprioceptive impairments compared to healthy controls, evidenced by deficits in joint position sense, movement sense, and force sense [118]. Instability can coexist and may be associated with refractory lateral epicondylitis [123].

Classification

Pathophysiological Basis: Epicondylitis results from tendinous microtearing followed by an incomplete reparative response rather than active inflammation [15].

Baker and Jones: This system classifies arthroscopic changes seen in lateral elbow tendinopathy into three distinct patterns [114]. * Type I: Characterized by inflammation and fraying deep to the extensor carpi radialis brevis with no tear [114]. * Type II: Characterized by linear tears at the undersurface of the extensor carpi radialis brevis [114]. * Type III: Characterized by retracted, partial, or complete avulsions of the extensor carpi radialis brevis [114].

Capsular Fold Classification: This system is based on the relationship of a degenerative capsular fold to the radial head [62]. * Type 1: The radial head is completely exposed [62]. * Type 2: Partial coverage of the radial head by the capsuloligamentous complex without interposition into the joint in any position [62]. * Type 3: Subluxation of the capsular edge into the radiocapitellar joint [62]. * Type 4: Described in relation to the capsular fold and radial head, though the specific definition is truncated in the provided excerpt [62].

MRI Classification: A proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis [64].

Other Considerations: A potential classification model for individuals with tennis elbow categorizes patients using information from common signs and symptoms to assist therapists in identifying appropriate treatment options [104]. There is a lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain, associated with considerable terminological heterogeneity [41].

Clinical Presentation

Lateral epicondylitis is a painful and functionally limiting entity affecting the upper extremity [20]. The condition has an estimated prevalence of 3% [50] and most frequently afflicts individuals between the ages of 35 and 65 years [50]. Although the natural course is self-limiting, typically resolving within 12 to 18 months [54], approximately 20% of patients experience disabling pain that restricts their professional and social lives [50]. The transient symptoms observed in tennis elbow reflect this self-limiting natural history [25].

Patients most often complain of pain at or around the bony prominence of the lateral epicondyle [51]. This pain often radiates down the forearm in line with the common extensor muscle mass [51] and occasionally radiates proximally into the upper arm [51]. Symptoms are usually triggered or exacerbated by contraction of the common extensor mass during various activities [51]. The intensity of pain ranges from intermittent and mild to constant and severe [51], with severe cases affecting all daily activities [51]. Pain can also occur at night, causing disturbance in sleep [51].

Inspection is unlikely to reveal obvious abnormalities [51]. However, in patients with longstanding disease or a history of previous corticosteroid injections, prominence of the bony epicondyle may be visible due to muscle wasting [51] or partial or complete rupture of the extensor tendon at its attachment [51]. Additionally, depigmentation or thinning of the overlying skin may result from corticosteroid injection [51].

Tenderness is typically found on palpation at the site of insertion of the ECRB tendon, which is just anterior to the anterior border of the lateral epicondyle [51]. Not uncommonly, tenderness is more diffuse, centred around the lateral epicondyle [51], and a point of tenderness may be found at the bony prominence itself [51].

Usually, a full range of active and passive movement is maintained at the elbow [51]. In more severe cases, pain occurs at the limit of elbow extension when the forearm is fully pronated [51]. Resisted middle finger extension can be painful owing to selective recruitment of the ECRB tendon, a finding known as Maudsley's test [51]. Resisted wrist extension with the elbow fully extended and in pronation stresses the whole of the common extensor origin [51].

Investigations

Diagnostic Accuracy and Misdiagnosis: Persistent symptoms of tennis elbow are a poor indication for surgery, as the majority of patients experience symptom resolution without intervention. Surgeons are unable to reliably predict which patients will or will not improve with nonoperative treatment [4].

MRI: The proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis [64]. Increased MRI signal in the extensor carpi radialis brevis (ECRB) origin is common in both symptomatic and asymptomatic elbows [65]. 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 [112]. Despite MRI evidence of a partial ECRB tear, nonsurgical treatment may be a viable option for some patients with recalcitrant lateral epicondylitis [113]. The clinical use of MRI in the management of patients with enthesopathy of the ECRB origin merits further study [122]. In recovered and unrecovered groups, improvement of tendinopathy area was 60% versus 16%, indicating that postoperative MRI findings reflect clinical outcomes [129].

CT: Computed tomography arthrography (CTA) was a reliable and accurate diagnostic modality compared with MRI to detect the capsular tear in patients with chronic tennis elbow [117].

Other Considerations: The Patient-Rated Tennis Elbow Evaluation is not recommended for use as an outcome measure in studies evaluating interventions for lateral epicondylitis until further development and validation are performed [42].

Treatment

Non-Operative

Nonsurgical treatment remains the mainstay of management for lateral epicondylitis [29]. Approximately 90% of patients with untreated tennis elbow achieve symptom resolution at one year [13], with the probability of recovery remaining fairly constant over the first year regardless of prior symptom duration [12]. Symptoms exhibit a steady half-life of three to four months, indicating that longer symptom duration does not predict a poorer prognosis without surgery [5]. Surgeons are unable to reliably predict which patients will improve with nonoperative treatment [4]. While at best all nonsurgical treatments provide only small pain relief while increasing the odds of adverse events [115], specific interventions may be considered for recalcitrant cases. Ultrasonographically guided percutaneous radiofrequency lesioning [93] and non-invasive techniques such as extracorporeal shock wave therapy [95] should be considered prior to surgery. Autologous tenocyte injection has shown significantly improved clinical function and structural repair at the origin of the common extensor tendon in patients with chronic lateral epicondylitis who previously underwent an unsuccessful full course of nonoperative treatment [17]. The author recommends against using platelet-rich plasma or autologous blood injections in patients with lateral epicondylitis [94].

Operative

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

Surgical Approach / Technique: After surgical treatment for lateral elbow tendonopathy, pain relief and restoration of elbow function can be achieved [2]. Surgical release of the fibrous attachments to the epicondyle yields excellent or good results in 95.9% of patients [131]. In a review of 21 elbow operations in 17 patients who underwent a percutaneous release, 20 of 21 elbows resumed normal function with an Andrews-Carson rating of approximately 198/200 [16]. Arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period [33], and is a valid technique for the treatment of recalcitrant lateral epicondylitis [34]. Both the Nirschl procedure and arthroscopic extensor carpi radialis brevis débridement are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy [36]. In a study of 30 patients with recalcitrant symptoms, arthroscopic resection of the radiocapitellar capsular complex resulted in complete relief of symptoms in 28 patients within 2 weeks of surgery [62], with an average time until return to work of 7 days [62]. A study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow [11]. While symptoms of refractory lateral humeral epicondylitis can be successfully treated by lateral humeral epicondylectomy, this success may be achieved through the denervation component rather than the release of the common extensor muscle origins [71]. A strategy of denervation surgery for lateral epicondylitis was effective for pain relief among patients showing a positive response to the block test [111], with success rates of 75% to 80% [18]. Patients who received a suture anchor for functional recovery had faster rehabilitation at 6 weeks postoperatively in terms of both functional outcome scores and grip and wrist extension strength measures [133]. Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis [132].

Surgical Technique Details: Arthroscopic tennis elbow release is performed with the patient in the lateral decubitus position with the arm hanging over an armrest with the elbow at 90 degrees [49]. A proximal anteromedial portal for viewing with a 30° 4.0-mm arthroscope is established, and a 3-mm outflow cannula is introduced through a posterolateral portal [49]. A modified working portal is established directly anterior to the lateral epicondyle at the border of the proximal attachment of the ECRB tendon as close to bone as possible [49]. The anterolateral capsule is released from the upper border of the lateral epicondyle down to the annular ligament with a 3.5-mm single-use bipolar radiofrequency electrode in vaporization mode [49]. The ECRB tendon is released from its bony insertion starting in the interval between the extensor carpi radialis longus and ECRB tendons [49]. For arthroscopic extra-articular release, the patient is placed in a lateral decubitus position with the arm positioned prone over a mid-humeral support with a tourniquet [100]. In extra-articular arthroscopic release, 15 ml of normal saline is injected into the elbow joint from the posterolateral soft spot to inflate the capsule [100]. A standard proximal-medial portal is used to gain access into the anterior compartment of the elbow, with attention to ensure protection of the antebrachial cutaneous and ulnar nerves [100]. An accessory proximal lateral portal is created that triangulates the area centered over the premarked lateral epicondylar point of maximal tenderness [100]. A 4-mm shaver is introduced into the accessory proximal lateral portal to shave bursal tissue and visualize the extensor carpi radialis brevis origin [100]. The extensor carpi radialis brevis origin on the humeral lateral condylar ridge in the region of the tender area is completely debrided [100]. For arthroscopic debridement, the patient is placed in the lateral decubitus position with the operative side up [103]. A rolled blanket or elbow stirrup attachment is positioned underneath the arm, allowing the elbow to move from 90 degrees of flexion to full extension [103]. A sterile tourniquet is placed on the arm at the midhumeral level [103]. The elbow joint is inflated with 30 mL of normal sterile saline solution through the soft spot outlined by the lateral epicondyle, radial head, and olecranon [103]. A standard medial viewing portal is established, and the arthroscope is introduced with a blunt trocar directed inferior toward the center of the anterior compartment of the elbow [103]. For arthroscopic repair described in Campbell's, the patient is placed prone on the operating table with two rolled towels longitudinally under the thorax [60]. The affected extremity is positioned with the ipsilateral shoulder abducted to 90 degrees and supported with a precut foam holder [60]. The joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [60]. The proximal medial or superomedial portal is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [60]. A 2.7-mm, 30-degree arthroscope is inserted into the joint to perform the diagnostic portion of the procedure [60]. The superolateral portal is established with an 18-gauge needle through the lesion [60]. A full-radius resector is used to excise the capsule to identify the undersurface of the extensor carpi radialis brevis tendon [60]. The capsule and pathologic tendinous attachment of the extensor carpi radialis brevis are debrided using a curet and motorized shaver [60]. The lateral epicondyle and lateral epicondylar ridge are decorticated with an arthroscopic burr, handheld instruments, or electrocautery [60]. For open release, the patient is positioned supine on the operating table with the affected arm resting on a hand table [127]. A 7.5-cm incision is made from 2.5 cm proximal to the lateral epicondyle to 5 cm distal to it, curving gently anteriorly [127]. The extensor carpi radialis longus is dissected from the aponeurosis proximally to the lateral epicondyle and distally to the level of the radial head [127]. The origin of the ECRB is incised and released by sharp dissection off the bone, encompassing approximately 75% of the tendinous origin [127]. All pathologic tissue is removed, and a small opening is made in the lateral capsule [127].

Complications and Considerations: Arthroscopic management of lateral epicondylitis has resulted in 1 posterior interosseous nerve transection and 1 partial median nerve laceration in a report of 2 cases [66]. Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management [32]. Arthroscopic and open lateral release procedures are not the same, with distinct advantages for the arthroscopic procedure including the capability to fully assess the elbow intra-articularly and the use of less appealing portal-site incisions [23]. No technique appears superior by any measure among open, percutaneous, and arthroscopic approaches for treating lateral epicondylitis [46].

Complications

Nerve palsy: Arthroscopic treatment of lateral epicondylitis carries risks of nerve injury, including posterior interosseous nerve transection and partial median nerve laceration [66]. In a series of surgical repairs for refractory medial epicondylitis, no ulnar nerve injuries were encountered [125].

Stiffness / Arthrofibrosis: A slight limitation in range of motion is a possible undesired consequence of arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow [73]. No elbow stiffness was encountered in a series of surgical repairs for refractory medial epicondylitis [125].

Other Considerations: Heterotopic ossification has been reported as a complication following elbow arthroscopy for lateral epicondylitis [69]. The incidence of failure requiring revision surgery for lateral epicondylitis is 1.5% in a population of 3863 patients [135]. Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis [135]. One patient required reoperation for pain and retearing at 1.5 years after index procedure for medial epicondylitis, having returned to national-level competitive swimming against medical advice within 3 months [125]. No infections were encountered in a series of surgical repairs for refractory medial epicondylitis [125]. Both arthroscopic and open debridement of the extensor carpi radialis brevis for lateral epicondylitis have low rates of 90-day adverse events with no significant differences between the two approaches [124].

Recovery

Other Considerations: Surgical treatment for lateral elbow tendonopathy achieves pain relief and restoration of elbow function [2]. Acute lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks [52]. The probability of recovery for untreated tennis elbow remained fairly constant over the first year regardless of prior symptom duration [12]. This constant probability of recovery over time undermines the concept that surgery is indicated if symptoms persist for an arbitrary duration [12]. Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up [38]. At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy demonstrated good durability of pain relief and functional recovery [137]. At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy was accompanied by sustained sonographic tissue healing with no significant deterioration [137].

Key Evidence

  • [L4] Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. [1] (10.1016/j.jhsa.2009.02.006)
  • [L4] After surgical treatment for lateral elbow tendonopathy, pain relief and restoration of elbow function can be achieved. [2] (10.1053/jhsu.2001.28432)
  • [L1] Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. [3] (10.1016/j.jhsa.2018.06.009)
  • [L2] Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it, and surgeons are unable to reliably predict who will or will not improve with nonoperative treatment. [4] (10.1097/corr.0000000000003425)
  • [L4] Symptoms of tennis elbow have a steady half-life of three to four months, indicating that longer symptom duration does not indicate a poorer prognosis without surgery, and failed nonoperative treatment should not be used as an indication for surgery unless reliable predictors of non-recovery are identified. [5] (10.1302/0301-620x.105b2.bjj-2022-0883.r1)
  • [L5] This article serves to provide an updated review of the various treatment options and management for lateral epicondylosis, noting that while most patients experience relief with non-operative management, controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases. [7] (10.1016/j.jhsa.2024.07.003)
  • [L5] Tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment is used, but for the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates. [9] (10.1016/j.arthro.2017.02.020)
  • [L4] Overall, the available data suggest that lateral epicondylitis often resolves spontaneously, warranting considerable circumspection before embarking on treatment. [10] (10.1016/j.otsr.2019.09.004)
  • [L2] With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow. [11] (10.1177/0363546517753385)
  • [L1] Approximately 90% of people with untreated tennis elbow achieved symptom resolution by 1 year, and the probability of recovery remained fairly constant over that timespan regardless of prior symptom duration, undermining the concept that surgery is indicated if symptoms persist for an arbitrary duration. [12] (10.1097/corr.0000000000002149)
  • [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. [13] (10.1097/corr.0000000000002058)
  • [L4] Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, but refractory cases may benefit from interventional therapies or surgical approaches. [14] (10.5397/cise.2019.22.4.227)
  • [L5] [15] (10.1016/j.jhsa.2009.01.022)
  • [L4] In a review of 21 elbow operations in 17 patients who underwent a percutaneous release, 20 of 21 elbows resumed normal function and had an Andrews-Carson rating of approximately 198/200. [16] (10.1097/00132589-200112000-00003)
  • [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. [17] (10.1177/0363546513504285)
  • [L5] The authors of the original study note that denervation of the lateral humeral epicondyle is one of many procedures described for the treatment of chronic tennis elbow, with success rates of 75% to 80%, and suggest that whether denervation is the mechanism of action for procedures involving an incision around the elbow might be answered by a randomized clinical trial. [18] (10.1177/0363546518783976)
  • [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. [19] (10.1016/j.jse.2009.12.016)
  • [L4] [20] (10.1016/j.jhsa.2007.07.019)
  • [L5] Arthroscopic and open lateral release procedures are not the same, with distinct advantages for the arthroscopic procedure including the capability to fully assess the elbow intra-articularly and the use of less appealing portal-site incisions. [23] (10.1016/j.arthro.2018.08.010)
  • [L4] The transient symptoms of tennis elbow seen in these two cases reflect the natural course of a self-limiting condition. [25] (10.1007/s00167-012-1939-0)
  • [L1] Pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment of lateral epicondylitis compared with observation only or placebo. [26] (10.1007/s11999-014-4022-y)
  • [L3] Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET). [27] (10.1016/j.jse.2025.10.006)
  • [L5] Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections. [29] (10.5435/00124635-200801000-00004)
  • [L5] Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management. [32] (10.1016/j.xrrt.2023.07.006)
  • [L4] The arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period. [33] (10.1007/s00167-005-0662-5)
  • [L2] Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. [34] (10.1016/j.arthro.2020.12.054)
  • [L3] Both techniques are comparable and highly effective for treating chronic recalcitrant lateral elbow tendinopathy. [36] (10.1016/j.jse.2016.09.022)
  • [L4] Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. [38] (10.1177/0363546515612758)
  • [L4] A misdiagnosis can occur in patients affected by longstanding lateral elbow pain. [39] (10.1177/03635465251319545)
  • [L4] Overall, clinical outcome scores showed improvement after arthroscopic extensor carpi radialis brevis release for refractory lateral epicondylitis. [40] (10.1016/j.arthro.2015.02.006)
  • [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. [41] (10.3390/healthcare10061095)
  • [L2] It is not recommended for use as an outcome measure in studies evaluating interventions for lateral epicondylitis until further development and validation are performed. [42] (10.1258/ht.2010.010014)
  • [L2] Magnetic resonance imaging is a reliable tool in determining radiological severity of lateral epicondylitis. [43] (10.1016/j.jhsa.2010.11.040)
  • [L4] [46] (10.1097/blo.0b013e3181483dc4)
  • [L4] [49] (10.1016/j.arthro.2015.10.008)
  • [L4] [50] (10.1177/17585732221146731)
  • [L5] [51] (10.1302/0301-620x.95b9.29285)
  • [L1] Acute lateral epicondylitis is a self-limiting condition where 3/4 of patients recover within 52 weeks. [52] (10.1186/s12891-015-0582-6)
  • [L5] Physical examination of the elbow is a critical component in formulating an accurate diagnosis. [53] (10.5435/jaaos-d-16-00622)
  • [L5] Lateral epicondylitis is a common condition with a self-limiting course of 12 to 18 months, and most patients are well-managed with non-operative treatment and activity modification, though many surgical techniques exist for refractory symptoms. [54] (10.1302/2058-5241.1.000049)
  • [L4] [62] (10.1097/01.blo.0000176143.08886.fe)
  • [L4] [63] (10.1016/j.arthro.2017.01.042)
  • [L4] The proposed MRI classification has emerged as one of the most reliable methods to define stages of chronic lateral epicondylitis. [64] (10.1186/s12891-022-05758-z)
  • [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. [65] (10.1016/j.jse.2016.01.033)
  • [L4] [66] (10.1016/j.jhsa.2012.01.038)
  • [L4] To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. [69] (10.1177/1558944716668844)
  • [L5] Contact pressure between the bone and tendon at the origin of the common extensor tendons is significantly increased with elbow extension, forearm pronation, and varus stress to the elbow under tension of the extensor tendons. [70] (10.1016/j.jhsa.2010.10.005)
  • [L4] While symptoms of refractory lateral humeral epicondylitis can be successfully treated by lateral humeral epicondylectomy, this success may be achieved through the denervation component rather than the release of the common extensor muscle origins. [71] (10.1007/s11552-011-9318-8)
  • [L4] A slight limitation in range of motion is a possible undesired consequence of this intervention. [73] (10.1007/s00167-017-4531-9)
  • [L4] This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention. [93] (10.1177/0363546511417096)
  • [L5] The author recommends against using these injections in patients with lateral epicondylitis. [94] (10.1097/corr.0000000000001249)
  • [L1] We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow. [95] (10.1016/j.hansur.2020.12.008)
  • [L3] [97] (10.1016/j.jse.2024.11.001)
  • [L5] [99] (10.1177/1558944718794008)
  • [L3] [100] (10.1016/j.xrrt.2021.07.005)
  • [L4] [103] (10.1016/j.jse.2010.02.008)
  • [L5] [104] (10.1016/j.jht.2012.06.007)
  • [L4] In patients with LET, clinicians can expect wrist extension strength at 0 and 90 to be similar. [108] (10.1016/j.jht.2020.03.019)
  • [L4] The clinical parameters of lateral epicondylitis may be influenced by several factors. [109] (10.1186/s13018-021-02406-5)
  • [L4] Our strategy of denervation surgery for lateral epicondylitis of the elbow was effective for pain relief among patients showing a positive response to the block test. [111] (10.1016/j.jses.2019.10.102)
  • [L3] Although there is variation in the use of MRI for lateral epicondylitis and its use is associated with downstream effects, the routine use of MRI for the diagnosis of lateral epicondylitis is low. [112] (10.1016/j.jhsa.2023.03.025)
  • [L3] Despite MRI evidence of a partial ECRB tear, nonsurgical treatment may be a viable option for some patients with recalcitrant lateral epicondylitis. [113] (10.1016/j.jseint.2021.11.017)
  • [L4] [114] (10.1111/sae.12025)
  • [L1] At best, all treatments provided only small pain relief while increasing the odds of adverse events. [115] (10.1177/0363546518801914)
  • [L3] Proprioception seems to be poorer in elbows with lateral epicondylitis than in the controls' elbows, which needs to be taken into consideration in the management of lateral epicondylitis. [116] (10.1016/j.jse.2007.07.003)
  • [L2] CTA was a reliable and accurate diagnostic modality compared with MRI to detect the capsular tear in patients with chronic tennis elbow. [117] (10.1016/j.jse.2010.12.002)
  • [L3] This study demonstrated that patients with lateral epicondylitis exhibit significant cervical proprioceptive impairments compared to healthy controls, as evidenced by deficits in joint position sense, movement sense, and force sense. [118] (10.1186/s12891-025-09026-8)
  • [L3] The clinical use of MRI in the management of patients with enthesopathy of the ECRB origin merits further study. [122] (10.1016/j.jhsa.2009.02.023)
  • [L1] Instability can coexist and may be associated with refractory lateral epicondylitis. [123] (10.1177/0363546520980133)
  • [L3] For lateral epicondylitis, both arthroscopic and open debridement of the extensor carpi radialis brevis were found to have low rates of 90-day adverse events, with no significant differences between the 2 approaches. [124] (10.1016/j.arthro.2022.08.022)
  • [L4] [125] (10.1016/j.jse.2015.03.017)
  • [L2] [127] (10.1016/j.arthro.2018.07.008)
  • [L4] In the recovered and unrecovered groups, improvement of tendinopathy area was 60% versus 16%, indicating that postoperative MRI findings reflect clinical outcomes. [129] (10.1016/j.arthro.2022.07.019)
  • [L4] Surgical release of the fibrous attachments to the epicondyle is effective for patients with persistent epicondylitis who have failed conservative therapy, with 95.9% achieving excellent or good results. [131] (10.2106/00004623-195335020-00015)
  • [L1] Radiofrequency microtenotomy provides a promising alternative to the release operation for elbow tendinosis. [132] (10.1177/0363546508318045)
  • [L1] Patients who received a suture anchor did have faster rehabilitation at 6 weeks postoperatively in terms of both functional outcome scores and grip and wrist extension strength measures. [133] (10.1016/j.jse.2022.11.019)
  • [L4] The incidence of failure requiring revision surgery for lateral epicondylitis in the studied population is low (1.5%). [135] (10.1016/j.jse.2016.10.022)
  • [L4] At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy demonstrated good durability of pain relief and functional recovery that was previously achieved, accompanied by sustained sonographic tissue healing with no significant deterioration. [137] (10.1177/03635465211010158)

See Also

References

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

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

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

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

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

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