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Elbow

Tennis Elbow Treatment Options

Lateral epicondylitis—often called tennis elbow—is a common cause of pain on the outside of the elbow. It occurs where the forearm extensor tendons attach to the lateral epicondyle of the humerus. Despite its name, this condition is usually not caused by inflammation, but rather by degeneration and micro-tearing of the tendon, particularly the extensor carpi radialis brevis (ECRB).

Because of this, successful treatment focuses on gradually restoring tendon health and strength, reducing excessive strain, and addressing contributing factors rather than simply “calming inflammation.”

Yes. Most patients improve with nonoperative treatment, and many recover fully without injections or procedures. The foundation of treatment is activity modification combined with a structured rehabilitation program. Early improvement may take weeks, and full recovery can take several months, but patience and consistency are key.

Physical therapy is the cornerstone of treatment for lateral epicondylitis. Therapy is designed to gradually rebuild the tendon’s ability to tolerate load rather than rest it indefinitely. A well-designed program typically includes progressive strengthening of the wrist extensors—often using eccentric or heavy-slow resistance exercises—along with shoulder, scapular, and core strengthening to reduce stress on the elbow during gripping and lifting.

Therapists may also address flexibility, posture, and work or sport-specific mechanics. When performed consistently, physical therapy leads to meaningful improvement for most patients over 6–12 weeks, though longer programs are sometimes required for chronic symptoms.

A counterforce brace, worn around the upper forearm just below the elbow, works by reducing the amount of force transmitted to the tendon attachment during gripping activities. While it does not directly heal the tendon, it can significantly reduce pain during daily activities and exercise.

Many patients find that a counterforce brace allows them to continue working, exercising, or participating in therapy with fewer symptom flare-ups. It is best used as a supportive tool alongside rehabilitation, not as a stand-alone treatment.

A cock-up wrist splint holds the wrist in a neutral or slightly extended position, reducing activation of the extensor tendons. This can be especially helpful for patients whose pain is aggravated by typing, manual labor, lifting, or repetitive wrist motion.

Wrist splints are typically used short-term, such as during work hours or at night, to calm symptoms while the tendon recovers and strengthening progresses.

Mill’s maneuver is a classic exam test for lateral epicondylitis, but it can also be used therapeutically as a controlled stretching technique. It involves extending the elbow while gently flexing the wrist and pronating the forearm to stretch the extensor tendon complex.

When used correctly and gently, this stretch can improve flexibility and reduce stiffness. However, it should be introduced cautiously—overly aggressive stretching can worsen symptoms. The goal is a mild, tolerable stretch, not sharp pain.

Corticosteroid injections can provide short-term pain relief, often within days. This can be helpful when pain is severe enough to interfere with sleep, work, or participation in therapy.

However, research has shown that steroid injections may be associated with higher recurrence rates and worse long-term outcomes compared with rehabilitation alone. For this reason, they are best used selectively—as a temporary pain-management tool rather than a definitive solution—and ideally paired with a clear rehabilitation plan.

PRP injections aim to stimulate a healing response in degenerative tendon tissue by delivering a concentrated sample of the patient’s own platelets to the affected area. Unlike steroids, PRP is not designed to provide immediate pain relief. Instead, improvement is usually gradual over several weeks to months.

PRP is often considered for patients who have had symptoms for several months despite appropriate therapy, or for those who want to avoid corticosteroids. While results vary, many patients experience meaningful improvement when PRP is combined with a structured rehabilitation program.

The TenJet procedure is a minimally invasive option for patients with persistent lateral epicondylitis that has not responded to conservative care. Using ultrasound guidance, a small device is inserted through a tiny incision and uses pressurized saline and ultrasonic energy to remove damaged tendon tissue while preserving healthier fibers.

TenJet is typically performed as an outpatient procedure and does not require large incisions. Recovery is usually faster than traditional surgery, but post-procedure rehabilitation remains essential to restore strength and function. TenJet is often considered a bridge between injections and surgery.

Surgery is reserved for patients with persistent, function-limiting symptoms after an extended course of nonoperative treatment—often 6–12 months or longer—or after failure of procedures such as PRP or TenJet.

Surgical treatment typically involves removing degenerative tendon tissue and, when appropriate, repairing or releasing the affected portion of the common extensor origin. Surgery can be performed using open or arthroscopic techniques. Outcomes are generally very good in carefully selected patients, though recovery requires a period of protection followed by gradual strengthening.

Lateral epicondylitis can be frustrating and slow to resolve, but the majority of patients improve with a thoughtful, stepwise treatment approach. Physical therapy, bracing, and activity modification form the foundation of care, while injections, TenJet, and surgery are reserved for cases that do not improve over time. Matching the right treatment to the right patient is key to achieving durable pain relief and a return to normal function.

If you have persistent pain on the outside of your elbow that is affecting work, exercise, or daily activities, contact Dr. José Vega’s office in Cleveland to schedule a consultation. A personalized evaluation can help determine which treatment options are most appropriate for your symptoms, goals, and timeline.

References

  1. Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015;24(1):67-73.
  2. 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;309(5):461-469.
  3. Coombes BK, Bisset L, Vicenzino B. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther. 2015;45(11):938-949.
  4. Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42(2):463-471.
  5. Sanders TL, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015;43(5):1066-1071.
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Dr. Jose Vega

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