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Tennis Elbow (Lateral Epicondylitis)

What is Tennis Elbow?

  • Tennis elbow, or lateral epicondylitis, is one potential cause of pain over the outside or lateral elbow. The tendon that attaches to the outside of the elbow extends the fingers and wrist.
  • Once thought to be a result of inflammation, research has shown that tennis elbow is due to degeneration or partial tearing of the common extensor tendon. These injuries to the tendon are often from overuse and gradual ward and tear. Often there is no specific injury, but symptoms can worsen with activity.

  • Patients will typically report pain or burning over the outside of the elbow. Weak grip strength is common.

How is Tennis Elbow diagnosed?

  • The diagnosis of this condition is mainly based on symptom presentation as well as physical examination findings. Often people would want x-rays done to evaluate their elbow pain, however, for the case of tennis elbow typically there are not prominent findings on the radiographs.

  • Calcifications may be present along the proximal end (end by the elbow) of the common extensor tendon; however, this is the only relevant finding on x-ray.

  • Utilizing ultrasonography (US), this allows for a more comprehensive, real-time view of the elbow and surrounding structures. If there is a degenerative tear present, there will be thickening of the tendon visible. A full-thickness tear of the tendon results in disruption of the fibers on US. (Keijsers, 2018)

What are my treatment options?

Conservative Treatment

  • In the majority of cases, tennis elbow resolves over time with conservative management, including physical therapy, non-steroidal anti-inflammatory medications (i.e. Motrin, ibuprofen, Aleve, naproxen), and cortisone (steroid) injections.
  • Recent studies have shown that cortisone injections can help for a few months, but may inhibit healing long-term. Studies have shown that cortisone injections can kill healthy tendon cells, and may actually make tennis elbow worse in the long run. In a study by Coombes et al. in the Journal of the American Medical Association (JAMA), patients that receive a cortisone injection do worse at the one-year follow-up than those that receive a placebo injection

Ultrasound Guided Needle Tenotomy using the TENEX device

  • Ultrasound guided needle tenotomy was first described by McShane et al in 2006, and involved repeatedly fenestrating the diseased tendon. This disrupted the abnormal tendon and stimulated a healing response.

  • The Tenex needle uses ultrasonic technology to perform the tenotomy, and has a high rate of success when compared to a simple percutaneous needle tenotomy. The first study looking at Tenex by Koh et al. in 2013 showed that 95% of patients were satisfied with the procedure

  • Learn more about TENEX here


  • One of the best-studied treatments for tennis elbow is platelet-rich plasma (PRP) injections. PRP is performed in the office and involves taking blood from a vein in the arm, concentrating the platelets in a centrifuge, and injecting the PRP into the tears within the tendon. Unlike cortisone injections, PRP should not wear off and will hopefully heal the tendon. When comparing PRP to steroids, Gosens et al. showed PRP to be more effective.

  • Learn more about PRP here


  • Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6;309(5):461-9. doi: 10.1001/jama.2013.129. PMID: 23385272.
  • Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011 Jun;39(6):1200-8. doi: 10.1177/0363546510397173. Epub 2011 Mar 21. PMID: 21422467.
  • Keijsers, R., de Vos, R. J., Kuijer, P. P. F., van den Bekerom, M. P., van der Woude, H. J., & Eygendaal, D. (2019). Tennis elbow. Shoulder & elbow, 11(5), 384–392.

  • Koh JS, Mohan PC, Howe TS, Lee BP, Chia SL, Yang Z, Morrey BF. Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: early clinical experience with a novel device for minimally invasive percutaneous microresection. Am J Sports Med. 2013 Mar;41(3):636-44. doi: 10.1177/0363546512470625. Epub 2013 Jan 9. PMID: 23302261.

  • McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med. 2006 Oct;25(10):1281-9. doi: 10.7863/jum.2006.25.10.1281. PMID: 16998100.