Tennis Elbow Info In-depth Evidence
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Also on YouTube.
Video transcript
Tennis elbow is a condition where you get pain on the outside of your elbow, right where the forearm tendons attach to the bone. It often starts as a nagging ache. The ache sharpens when you grip, lift, or twist. Despite the name, most patients do not play tennis. The pain can spread down the forearm as a burning sensation, and the sore spot is usually tender to press. Most cases settle without surgery. The tendon needs time and specific exercises to heal. A gradual progressive loading program, usually guided by a physiotherapist, is the best initial treatment. A counterforce brace can take the edge off during the day, and easing the activities that flare it up also helps. Most people improve over weeks to months. When the pain persists despite a fair trial of non-operative treatment, a small operation can help. It is done as day surgery through a short incision over the outer side of the elbow. The worn and painful part of the tendon is cut away, leaving healthy tendon to heal back to the bone, which may be helped with sutures. The procedure itself is quick, and you go home the same day, with the elbow in a simple dressing. Recovery is gradual. The arm is rested in a sling for comfort over the first few days. Gentle movement begins early, and most people are using the hand for light tasks within a couple of weeks. Strength returns over the following months, with heavy gripping and lifting last to return. It is normal for the elbow to grumble as it settles. The improvement is steady, and worth the wait.
What you're feeling
You are likely feeling a dull ache or sharp pain on the outside of your elbow. This area is called the lateral epicondyle. The discomfort often starts near the bony bump on the outside of your elbow and may travel down your forearm. You might notice that the pain feels stiff when you first wake up in the morning.
The pain usually gets worse when you use your arm to lift things. Simple daily tasks can become difficult. You may struggle to lift a kettle from the bench. Turning a doorknob or shaking hands can send a sharp sting through your elbow. Holding a cup of coffee or using a screwdriver may also cause discomfort. These actions put stress on the tendons that connect your forearm muscles to your elbow bone.
In most cases, this condition is self-limiting. This means it tends to get better on its own over time. Symptoms have a steady half-life of three to four months. This means the intensity of your pain often reduces significantly within that period. Approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year. The probability of recovery remains fairly constant over this timespan, regardless of how long you have had symptoms. Longer symptom duration does not indicate a poorer prognosis without surgery.
Tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment is used. However, if your symptoms persist, it is important to understand that persistent tennis elbow symptoms are a poor indication for surgery. The majority of patients experience symptom resolution without it. Surgeons are unable to reliably predict who will or will not improve with nonoperative treatment of chronic tennis elbow.
If you find that your pain is interfering with your sleep or daily activities, you should discuss this with your surgeon. They will examine your elbow to confirm the diagnosis. Physical examination of the elbow is a critical component in formulating an accurate diagnosis. Nearly half (46.5%) of patients presenting with lateral elbow pain receive a diagnosis other than lateral elbow tendinopathy (LET). Your surgeon will ensure that your symptoms match the condition and rule out other causes.
What's actually happening
Tennis elbow is a wear-and-tear injury to the tendons on the outside of your elbow. These tendons act like strong ropes, connecting your forearm muscles to the bony bump on the outside of your elbow joint. When you grip objects or lift things, these ropes pull tight. Over time, this repeated stress can cause tiny tears in the tendon fibres.
Think of the tendon origin as a frayed rope anchor. Instead of a smooth, strong connection to the bone, the tissue becomes irritated and inflamed. This causes pain when you extend your wrist or grip items. The pain is often worst when you try to lift a cup or shake hands.
Your body tries to heal these micro-tears, but the constant strain can outpace the repair process. This leads to a cycle of ongoing irritation. The tendon may also become less sensitive to position, making your elbow feel less stable. This loss of proprioception means your brain receives less clear information about where your arm is in space.
In some cases, the body deposits extra bone in the area as it attempts to stabilise the joint. This is called heterotopic ossification. It can further limit movement and cause discomfort.
Most people recover without surgery. About 90% of people with untreated tennis elbow achieve symptom resolution by 1 year. Symptoms have a steady half-life of three to four months. This means the pain gradually fades over time for many patients. Longer symptom duration does not indicate a poorer prognosis without surgery.
However, if your symptoms persist, the tendon damage may be significant. Surgery aims to remove the damaged tissue and stimulate healing. Arthroscopic tennis elbow release provides symptomatic improvement in most patients with lateral epicondylitis. For the small percentage of patients who do not respond to nonoperative approaches, surgery provides near 90% satisfaction rates.
We focus on addressing the root cause of the irritation. This includes assessing the tendon and surrounding structures to ensure a comprehensive treatment plan.
What we can do about it
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Tennis elbow is a common condition with a self-limiting course of 12 to 18 months. Most people find relief through simple self-care and physiotherapy. You can expect symptoms to have a steady half-life of three to four months. This means your pain should gradually ease over time. We recommend activity modification to avoid movements that strain the outer elbow. Physiotherapy aims to strengthen the forearm muscles and improve tendon health. You should give this approach a fair trial, as approximately 90% of people with untreated tennis elbow achieve symptom resolution by 1 year. Longer symptom duration does not indicate a poorer prognosis without surgery.
If self-care is not enough, we may discuss medical management. This can include pain medication and anti-inflammatory treatments to help manage discomfort. We also consider injections to reduce inflammation and support healing. However, the evidence shows that platelet-rich plasma or autologous blood injections do not reduce pain or improve function in patients with lateral tennis elbow. Cortisone or hyaluronic acid injections may provide short-term relief, but all nonsurgical treatments for this condition provide only small pain relief while increasing the odds of adverse events. We focus on treatments that actively improve pain relief or accelerate soft tissue healing. You should discuss which injection type suits your specific situation during your consultation.
Surgery is considered only when conservative care has reached its limit. Persistent tennis elbow symptoms are a poor indication for surgery as the majority of patients experience symptom resolution without it. Surgeons are unable to reliably predict who will or not improve with nonoperative treatment. 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. This procedure involves making small incisions to remove damaged tissue and relieve pressure on the tendon. We view this as a shared decision, ensuring you understand the benefits and risks before proceeding.
Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment (history, examination, and imaging where needed) establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement.
What to expect
Tennis elbow, also known as lateral epicondylitis, is a condition where the tendons on the outside of your elbow become irritated. The good news is that this condition often settles on its own. Approximately 90% of people see their symptoms resolve within one year, even without any specific treatment. Your symptoms have a steady half-life of three to four months, meaning they tend to improve gradually over time. About three-quarters of patients recover within 52 weeks.
It is important to know that the length of time you have had pain does not predict how long it will take to heal. The probability of recovery remains fairly constant regardless of how long your symptoms have persisted. Tennis elbow typically resolves by six months in most cases, no matter what treatment approach is used. Because the natural history of this condition is so positive, persistent symptoms are generally a poor indication for surgery. Most patients experience symptom resolution without needing an operation.
Your surgeon is unable to reliably predict which specific patients will or will not improve with non-surgical treatment. Therefore, failed non-surgical treatment should not be used as the sole reason for surgery unless reliable predictors of non-recovery are identified. For the small percentage of patients who do not respond to non-surgical approaches, surgery provides near 90% satisfaction rates. Surgical interventions may be performed with a high rate of success when conservative measures are unsuccessful.
Recovery feels like a gradual return to normal activity. You may notice a steady improvement in function over weeks to months. While there is some controversy regarding the optimal modality for the quickest recovery, focusing on the upper segments of your arm in addition to the elbow is essential for management. Whether you choose non-surgical management or surgery, the goal is to reduce pain and restore your ability to use your arm without discomfort.
When to see someone
See your GP if your elbow pain does not improve with rest. Most people recover within six months without surgery. Your symptoms have a steady half-life of three to four months. Longer duration does not mean a poorer outcome. Ask for a specialist review if you have weakness, instability, or locking. Seek help if pain interferes with sleep or work. Sudden worsening also warrants assessment. Physical examination is critical for an accurate diagnosis. Nearly half of patients with lateral elbow pain receive a different diagnosis. Do not assume surgery is needed if non-surgical treatments fail. Approximately 90% of people achieve symptom resolution by one year without it.
Advanced reading: the deeper science (optional)
This section goes further than you need for your own treatment decisions. Tennis elbow is worth the extra reading because it is one of the conditions where the treatment that feels most effective in the first month is the one that does worst by the end of the year.
The condition mostly cures itself, slowly
Left alone, tennis elbow settles. In the trial discussed below, the group randomised to simply wait and see — no injection, no physiotherapy — was reassessed at 52 weeks, and 56 of 62 (90%) reported themselves either much improved or completely recovered [1].
That figure is the yardstick every treatment has to be measured against. An intervention is only worth having if it beats getting better on your own, and getting better on your own is what usually happens.
The corticosteroid paradox
A landmark randomised trial compared corticosteroid injection, physiotherapy, and simply waiting, following people for a full year [1].
At six weeks the injection looked excellent. Success was reported by 51 of 65 (78%) of the injection group against 16 of 60 (27%) of those waiting — a number needed to treat of 2 [1].
Then it reversed. Of those early successes, 47 of 65 (72%) subsequently regressed. By 52 weeks the injection group was significantly worse than the physiotherapy group on every outcome, and worse than the people who did nothing on two of the three primary measures [1].
The authors' own explanation is worth repeating: the injection relieves pain so quickly that people resume loading a tendon that has not actually healed. The trial's conclusion was that corticosteroid "should be used with caution" in tennis elbow — a striking thing to say about the treatment most people expect to be offered.
This is why an injection here is a considered decision about short-term function, not a default, and why it is not a substitute for the loading programme.
So what is worth doing
Physiotherapy beat waiting at six weeks on every measure, and by 52 weeks the two were indistinguishable because nearly everyone in both groups had recovered [1]. Its value is therefore in getting you through the painful months faster, not in changing the destination. Notably, the physiotherapy group also sought less additional treatment along the way [1]. Given that, the sensible plan is load management and a progressive tendon programme, accepting that the timeline is measured in months.
Surgery is reserved for the small minority still disabled after a genuine and prolonged trial of non-operative care. The reason that threshold is set high is precisely the natural history above: operate early and you are competing against a condition that was, in nine cases out of ten, going to resolve anyway.
References for the advanced reading
- Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview
- Tennis elbow diagnosis and treatment concepts impact work participation [1].
- About 90% of people with untreated tennis elbow achieve symptom resolution at 1 year [2].
- Elbow arthroscopy is a safe modality of treatment for a variety of pathologies in experienced hands [4].
- Numerous treatment options exist for epicondylitis, but no single universally accepted protocol has emerged [5].
- Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management [7].
- Refractory cases of lateral epicondylitis may benefit from interventional therapies or surgical approaches [7].
- There is insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain due to small study numbers, large heterogeneity, small sample sizes, and poor outcome reporting [10].
- Pooled data from randomized controlled trials indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment of lateral epicondylitis compared with observation only or placebo [11].
- Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management [12].
- There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow [14].
- Most patients with lateral epicondylosis experience relief with non-operative management [16].
- Controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases of lateral epicondylosis [16].
- Surgical intervention for refractory medial epicondylitis often has a high success rate with patients generally demonstrating an improvement in patient-reported outcomes [24].
- Patients with refractory medial epicondylitis have an encouraging number returning to work with limited complications after surgical intervention [24].
- Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment, based on evidence with significant methodological limitations [26].
Anatomy & Pathophysiology
- Tennis elbow is a degenerative disease [8].
- The onset of tennis elbow is hastened by overuse of the arm and elbow [8].
- Lateral epicondylitis is associated with combined physical exertion and elbow movements [3].
- Biomechanical exposure involving wrist and/or elbow at work is associated with the incidence of lateral epicondylitis [34].
- Repetitive exposure to bending or straightening the elbow is a significant risk factor for medial and lateral epicondylitis [48].
- Self-reported physical exposures implicating repetitive and extensive/prolonged wrist bend/twisting and forearm movements are associated with incident cases of lateral and medial epicondylitis [50].
- Hypoechogenicity and bone changes indicate the presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia [13].
- Increased MRI signal in the extensor carpi radialis brevis (ECRB) origin is common in both symptomatic and asymptomatic elbows [31].
- The common extensor tendon (CET) is thicker in men and in the dominant elbow [49].
- There is no difference in CET thickness regarding age groups [49].
- Lateral epicondylalgia is characterized by considerable terminological heterogeneity and a lack of clear, recognized diagnostic criteria [17].
- Accurate diagnosis of medial epicondylitis requires distinguishing it from other elbow conditions [9].
- Treatment of medial epicondylitis is guided by the specific pathologic stage of the tendon [9].
- Persistent lateral elbow pain can result from overlooked posterolateral impingement of the elbow [22].
- Understanding the static and dynamic anatomy of the lateral part of the elbow is necessary for developing future treatment and preventive strategies [22].
- Arthroscopic tennis elbow release involves establishing a proximal medial or superomedial portal located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [42].
- During arthroscopic tennis elbow release, the joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [42].
- A 2.7-mm, 30-degree arthroscope is introduced into the joint through the proximal medial or superomedial portal, maintaining contact with the anterior aspect of the humerus [42].
- A superolateral portal is established with an 18-gauge needle through the lesion to identify the undersurface of the extensor carpi radialis brevis tendon [42].
- Pathologic tendinous attachment of the extensor carpi radialis brevis is debrided using a curet and motorized shaver, and the lateral epicondyle is decorticated [42].
- Decortication of the lateral epicondyle and lateral epicondylar ridge can be performed with an arthroscopic burr, handheld instruments, or electrocautery [42].
- A 70-degree arthroscope may be required in rare instances during arthroscopic tennis elbow release [42].
- Heterotopic ossification (HO) can develop after elbow arthroscopy for lateral epicondylitis [15].
Classification
- Tennis elbow is considered a degenerative disease [8].
- There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP) [17].
- There is a lack of clear and recognised diagnostic criteria for evaluating and treating patients with lateral elbow pain [17].
- Persistent tennis elbow symptoms have little prognostic value [2].
- No single universally accepted protocol has emerged for the treatment of epicondylitis [5].
- There is little clear consensus on which modality works best for both conservative and operative options for lateral epicondylitis [29].
- The understanding of the disease process of lateral epicondylitis is currently incomplete [29].
- Failed surgical treatment of lateral epicondylitis is multifactorial [12].
- Distinguishing the cause of failed surgical treatment of lateral epicondylitis is critical for appropriate management [12].
Clinical Presentation
- Tennis elbow is a degenerative disease whose onset is hastened by overuse of the arm and elbow [8].
- Lateral epicondylitis is a common, generally self-limiting tendinosis affecting patients aged 35 to 55 years [37].
- Lateral elbow tendinosis is relatively common, particularly among individuals aged 40 to 49 years [20].
- Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment [27].
- Nonoperative treatment for lateral and medial epicondylitis in athletes has a success rate of up to 90% [28].
- Lateral epicondylitis often resolves spontaneously, warranting considerable circumspection before embarking on treatment [18].
- Work-related risk factors for lateral epicondylitis include combined physical exertion and elbow movements [3].
- There is considerable terminological heterogeneity in the description of lateral elbow pain (LEP), associated with a lack of clear and recognised diagnostic criteria [17].
- The presence of hypoechogenicity and bone changes indicates a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia [13].
Investigations
- Tennis elbow is a degenerative disease, the onset of which is hastened by overuse of the arm and elbow [8].
- Combined physical exertion and elbow movements are strongly associated with lateral epicondylitis [3].
- Accurate diagnosis requires distinguishing lateral epicondylitis from other elbow conditions [9].
- Treatment is guided by the specific pathologic stage of the tendon in epicondylitis [9].
- No single universally accepted protocol has emerged for the diagnosis and management of epicondylitis [5].
- The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia [13].
- There is evidence to support the use of ultrasound in the detection of lateral epicondylitis [52].
- Routine use of MRI for the diagnosis of lateral epicondylitis is low [41].
- Lateral epicondyle calcifications are much more common in lateral epicondylitis than previously reported, possibly owing to modern digital radiography and magnification [53].
- Lateral epicondyle calcifications do not appear to be related to clinical factors including patient-reported measures [53].
Treatment
Natural History and Prognosis
- Approximately 90% of people with untreated tennis elbow achieve symptom resolution at 1 year based on placebo or no-treatment control arms of randomized trials [2].
- Lateral epicondylitis is a self-limited condition that usually resolves over a 12- to 18-month period without treatment [27].
- Lateral epicondylitis has a self-limiting course of 12 to 18 months, with most patients well-managed with non-operative treatment and activity modification [35].
- The prognosis for medial epicondylitis in occupational settings is good, with a 3-year recovery rate of 81% [19].
Non-Operative Management
- Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections [38].
- Most patients with tennis elbow experience relief with non-operative management [16].
- Corticosteroid injections provide significant short-term benefits for tennis elbow, but these benefits are reversed after six weeks with high recurrence rates, implying the treatment should be used with caution [21].
- Peri-articular hyaluronic acid (HA) treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing [36].
- Normal saline (NS) injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis [39].
- Local platelet-rich plasma (PRP) injections were associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroid treatment for lateral epicondylitis at a follow-up of 6 months [40].
- Further investigations are needed regarding the effectiveness of eccentric exercise therapy for epicondylar tendinopathy [6].
Operative Management
- Surgical intervention for refractory medial epicondylitis often has a high success rate, with patients generally demonstrating an improvement in patient-reported outcomes and an encouraging number returning to work with limited complications [24].
- Surgical options for tennis elbow are reserved for recalcitrant cases [28].
- There is insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain due to a small number of studies, large heterogeneity in interventions, small sample sizes, and poor reporting of outcomes [10].
Clinical Practice and Consensus
- While numerous treatment options exist for epicondylitis, no single universally accepted protocol has emerged [5].
- There is little clear consensus on which modality works best for both conservative and operative options for lateral epicondylitis, indicating that the understanding of the disease process is currently incomplete [29].
- There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow in UK clinical practice [14].
Complications
- Corticosteroid injection for tennis elbow provides significant short-term benefits but reverses after six weeks with high recurrence rates [21].
- Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis but a negative effect in the intermediate term [25].
- Heterotopic ossification (HO) has been reported as a complication following elbow arthroscopy for lateral epicondylitis [15].
- Short-term complication rates appear comparable between open and arthroscopic surgical treatment for lateral epicondylitis [43].
- Medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction in pitchers is associated with an increased risk for further surgical intervention [45].
Recovery
- Enthesopathy of the extensor carpi radialis brevis origin is a benign, self-limiting disorder with a natural history of spontaneous resolution [33].
- No treatments have been proven to alter the course of enthesopathy of the extensor carpi radialis brevis origin [33].
- The prognosis for medial epicondylitis in occupational settings was good with a 3-year recovery rate at 81% [19].
- Poor prognosis at 1 year of follow-up for lateral epicondylitis was related to manual work and high baseline pain [46].
- No relation was found between the type of medical treatment given or chosen and prognosis for lateral epicondylitis at 1 year [46].
- Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis [25].
- Corticosteroid injections have a negative effect in the intermediate term for lateral epicondylitis [25].
- The significant short-term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates [21].
- Radial extracorporeal shock wave therapy (ESWT) was related to better effects in lateral epicondylitis [30].
- Symptom duration of longer than 6 months was related to better effects with radial ESWT for lateral epicondylitis [30].
- Short follow-up duration (less than 24 weeks) was related to better effects with radial ESWT for lateral epicondylitis [30].
- Due to heterogeneity in studies regarding disorder duration, shock wave therapy type, frequency, dose, management type, control group, follow-up timing, and outcomes assessed, a pooled meta-analysis of shock wave therapy for lateral elbow tendinopathy was considered inappropriate [55].
- Controversy remains regarding the optimal modality for quickest recovery in lateral epicondylosis [16].
- Controversy remains regarding the role of surgical intervention for refractory cases of lateral epicondylosis [16].
Key Evidence
- [L4] This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation. [1] (10.1177/1758573218797973)
- [L1] Based on the placebo or no-treatment control arms of randomized trials, about 90% of people with untreated tennis elbow achieve symptom resolution at 1 year. [2] (10.1097/corr.0000000000002058)
- [L4] This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral epicondylitis. [3] (10.1002/ajim.22140)
- [L4] In experienced hands, elbow arthroscopy is a safe modality of treatment for a variety of pathologies. [4] (10.1016/j.arthro.2007.03.080)
- [L5] This article is a review of recently published information on elbow tendinopathy and tendon ruptures intended to assist clinicians in diagnosis and management, noting that while numerous treatment options exist for epicondylitis, no single universally accepted protocol has emerged. [5] (10.1016/j.jhsa.2009.01.022)
- [L2] Further investigations are needed, not only focused on shoulder impingement or epicondylar tendinopathy, but on tendinopathies in other areas of the upper limb. [6] (10.1016/j.jsams.2015.06.007)
- [L4] Most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, but refractory cases may benefit from interventional therapies or surgical approaches. [7] (10.5397/cise.2019.22.4.227)
- [L4] The findings are consistent with the hypothesis that tennis elbow is a degenerative disease, the onset of which is hastened by overuse of the arm and elbow. [8] (10.1177/036354657900700405)
- [L5] Accurate diagnosis requires distinguishing it from other elbow conditions, and treatment is guided by the specific pathologic stage of the tendon. [9] (10.1016/j.csm.2004.04.011)
- [L1] Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain. [10] (10.1002/14651858.cd003525.pub2)
- [L1] Pooled data from RCTs indicate a lack of intermediate- to long-term clinical benefit after nonsurgical treatment of lateral epicondylitis compared with observation only or placebo. [11] (10.1007/s11999-014-4022-y)
- [L5] Failed surgical treatment of lateral epicondylitis is multifactorial, and distinguishing the cause is critical for appropriate management. [12] (10.1016/j.xrrt.2023.07.006)
- [L4] The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. [13] (10.1186/1471-2342-14-10)
- [L4] There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow. [14] (10.1177/1758573217738199)
- [L4] To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. [15] (10.1177/1558944716668844)
- [L5] This article serves to provide an updated review of the various treatment options and management for lateral epicondylosis, noting that while most patients experience relief with non-operative management, controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases. [16] (10.1016/j.jhsa.2024.07.003)
- [L1] In this SR, a considerable terminological heterogeneity emerged in the description of LEP, associated with the lack of clear and recognised diagnostic criteria in evaluating and treating patients with lateral elbow pain. [17] (10.3390/healthcare10061095)
- [L4] Overall, the available data suggest that lateral epicondylitis often resolves spontaneously, warranting considerable circumspection before embarking on treatment. [18] (10.1016/j.otsr.2019.09.004)
- [L2] The prognosis for medial epicondylitis in this population was good with a 3-year recovery rate at 81%. [19] (10.1097/01.jom.0000085888.37273.d9)
- [L3] The study indicates that lateral elbow tendinosis is relatively common, particularly among individuals aged 40 to 49 years. [20] (10.1177/0363546514568087)
- [L1] The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow. [21] (10.1136/bmj.38961.584653.ae)
- [L4] Further understanding of the static and dynamic anatomy of the lateral part of the elbow will help to develop future treatment and preventive strategies. [22] (10.5397/cise.2023.01081)
- [L4] Surgical intervention for refractory medial epicondylitis often has a high success rate with patients generally demonstrating an improvement in patient-reported outcomes and an encouraging number returning to work with limited complications. [24] (10.1177/03635465221095565)
- [L1] Corticosteroid injections have a shortterm beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. [25] (10.1136/bmjopen-2013-003564)
- [L1] Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. [26] (10.1177/1758573217745041)
- [L2] Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment. [27] (10.1007/s11552-014-9642-x)
- [Paper] The article reviews the pathology, clinical presentation, and treatment options for lateral and medial epicondylitis in athletes, noting that nonoperative treatment has a success rate of up to 90% and that surgical options are reserved for recalcitrant cases. [28] (10.1016/j.csm.2010.06.009)
- [L4] Although many treatments have been advocated for lateral epicondylitis, there is little clear consensus on which modality works best for both conservative and operative options, indicating that the understanding of the disease process is currently incomplete. [29] (10.1016/j.jhsa.2007.07.019)
- [L1] Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. [30] (10.1097/corr.0000000000001246)
- [L4] Increased MRI signal in the ECRB origin is common in symptomatic and in asymptomatic elbows. [31] (10.1016/j.jse.2016.01.033)
- [L5] Enthesopathy of the extensor carpi radialis brevis origin is a benign, self-limiting disorder with a natural history of spontaneous resolution, for which no treatments have been proven to alter the course. [33] (10.5435/jaaos-d-15-00233)
- [L2] The results of this meta-analysis strongly support the hypothesis of an association between biomechanical exposure involving wrist and/or elbow at work and incidence of lateral epicondylitis. [34] (10.1002/acr.22874)
- [L5] Lateral epicondylitis is a common condition with a self-limiting course of 12 to 18 months, and most patients are well-managed with non-operative treatment and activity modification, though many surgical techniques exist for refractory symptoms. [35] (10.1302/2058-5241.1.000049)
- [L1] Peri-articular HA treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing. [36] (10.1186/1758-2555-2-4)
- [L5] Lateral epicondylitis is a common, generally self-limiting tendinosis affecting patients aged 35 to 55 years. [37] (10.1302/0301-620x.95b9.29285)
- [L5] Nonsurgical treatment is the mainstay of management for lateral epicondylitis, involving options such as rest, physical therapy, and injections. [38] (10.5435/00124635-200801000-00004)
- [L1] NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. [39] (10.1177/0363546519899644)
- [L1] Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months. [40] (10.1016/j.ijsu.2019.05.003)
- [L3] Although there is variation in the use of MRI for lateral epicondylitis and its use is associated with downstream effects, the routine use of MRI for the diagnosis of lateral epicondylitis is low. [41] (10.1016/j.jhsa.2023.03.025)
- [L3] Surgical management of lateral epicondylitis varies depending on surgeons' fellowship training, and short-term complication rates appear comparable between open and arthroscopic treatment. [43] (10.1016/j.arthro.2017.04.078)
- [L3] Those who experience medial elbow pain are at increased risk for further surgical intervention. [45] (10.1177/2325967118808782)
- [L2] Poor prognosis at 1yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain, whilst no relation was found between the type of medical treatment given/chosen and prognosis. [46] (10.1093/rheumatology/keg360)
- [L4] Repetitive exposure to bending/straightening the elbow was a significant risk factor for medial and lateral epicondylitis. [48] (10.1093/rheumatology/ker228)
- [L3] This study presents the US characteristics and normal values of the CET, finding that the tendon was thicker in men and in the dominant elbow with no difference regarding age groups. [49] (10.1177/2325967117704186)
- [L2] Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study. [50] (10.1136/oemed-2012-101341)
- [L2] There is evidence to support the use of ultrasound in the detection of lateral epicondylitis. [52] (10.1016/j.otsr.2014.01.006)
- [L4] Lateral epicondyle calcifications are much more common in lateral epicondylitis than previously reported, possibly owing to modern digital radiography and magnification, although they do not appear to be related to clinical factors including patient-reported measures. [53] (10.1016/j.jhsa.2017.03.016)
- [L1] With current studies heterogeneous in terms of the duration of the disorder; type, frequency and total dose of SWT; period of time between SWT; type of management and control group; timing of follow-up and outcomes assessed, a pooled meta-analysis of SWT for lateral elbow tendinopathy was considered inappropriate. [55] (10.1093/bmb/ldm019)
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