Tennis elbow (lateral epicondylitis) is pain on the outer side of the elbow caused by overload and degeneration of the tendon that attaches the wrist-extensor muscles to the bone, mainly the extensor carpi radialis brevis (ECRB). Despite the name, most people who get it do not play tennis: it is common in people whose work or hobbies involve repetitive gripping, lifting and twisting. It is one of the most common conditions Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats.
- Most people get better without surgery, often within a year
- Exercise-based physical therapy, activity changes and a forearm strap are the foundation of treatment
- Cortisone injections relieve pain quickly, but symptoms often return and long-term results can be worse
- PRP injections can be considered for persistent symptoms; the research is promising but mixed
- Surgery is reserved for the small number of patients who do not improve after at least 6 months
What causes tennis elbow?
Tennis elbow is a tendinopathy, a degenerative condition of the tendon rather than simple inflammation, which is why some doctors call it lateral epicondylosis or epicondylalgia. In a population study, about 1.3% of working-age adults had definite tennis elbow at any one time; it was most common between ages 45 and 54 and was linked to smoking and to combined repetitive and forceful arm work.1
Symptoms
- Pain and tenderness over the bony bump on the outer side of the elbow
- Pain that can spread down the forearm
- Pain when gripping, shaking hands, lifting a coffee cup or a gallon of milk, or turning a doorknob or screwdriver
- Weaker grip
Diagnosis
The diagnosis is usually made from your history and examination: tenderness just in front of and below the outer elbow bone, and pain when the wrist or middle finger is extended against resistance. Dr. Dold also checks for other causes of outer elbow pain, such as radial tunnel syndrome (nerve irritation), elbow arthritis or ligament instability. Pain on the inner side of the elbow is usually golfer’s elbow instead. X-rays, ultrasound or MRI are used when the diagnosis is uncertain or before considering surgery.
Treatment without surgery
Tennis elbow often improves with time. In a randomized trial, 83% of patients assigned to a “wait-and-see” approach and 91% of those who had physical therapy reported success at one year.2 Dr. Dold’s first-line plan includes:
- Activity modification: reducing or changing the gripping and lifting tasks that provoke pain, without stopping activity altogether
- Physical therapy and a home exercise program, including progressive (eccentric) strengthening of the wrist extensors. Most studies of programs that include eccentric exercise report less pain and better function and grip strength.3 Physical therapy also speeds early recovery compared with waiting.4
- A counterforce strap (tennis elbow brace) worn just below the elbow during activity
- Ice and short courses of anti-inflammatory medicine for flare-ups
Injections
Cortisone (steroid) injections
Cortisone gives the fastest short-term relief, but the benefit often does not last. In one trial, 47 of 65 patients who initially improved after cortisone later relapsed.4 In another, recurrence at one year was 54% after cortisone compared with 12% after a placebo injection, and fewer patients had recovered at one year.5 A large review found the same pattern: strong short-term pain relief, reversed at 6 and 12 months.6 Dr. Dold uses cortisone selectively, for example when quick relief is needed, and discusses this trade-off with each patient.
Platelet-rich plasma (PRP)
PRP is made from a small sample of your own blood and injected into the damaged tendon. Several trials favor PRP over the longer term:
- In a double-blind trial of 100 patients, PRP was more often successful than cortisone at 2 years, and function scores in the cortisone group returned to baseline.7
- In a multicenter trial of 230 patients, PRP and tendon needling alone did not differ at 12 weeks, but PRP patients had more improvement in pain at 24 weeks (success rates of about 84% vs 68%).8
- An earlier network meta-analysis found both PRP and autologous blood injections statistically better than placebo, although most of the included trials had a high risk of bias.9
- A 2026 network meta-analysis of 41 trials found that cortisone worked best in the short term with a later rebound, while PRP appeared to provide more sustained pain relief.10
The evidence is not uniform: one placebo-controlled trial found no difference between PRP, cortisone and saline at 3 months.11 PRP preparations also vary. Complications are generally mild; the most common is temporary pain at the injection site.12 PRP is often not covered by insurance. Dr. Dold has published a systematic review of PRP for cartilage damage13 and will help you decide whether it is a reasonable option for you.
Surgery
Surgery is considered when significant pain persists after at least 6 months of good non-surgical treatment. Dr. Dold performs an open debridement: through a small incision on the outer elbow, the damaged portion of the ECRB tendon is removed and the area is cleaned to encourage healing. Arthroscopic and percutaneous techniques are also used by some surgeons. A systematic review of treatment for persistent tennis elbow found promising results across open, arthroscopic and percutaneous techniques, with no clear best method.14 In a long-term study of the mini-open technique, 84% of elbows had good or excellent results at 10 to 14 years, and 93% of patients returned to their sports.15
Patients should also know that a small placebo-controlled trial found no extra benefit from removing the diseased tendon compared with a sham operation; both groups improved.16 This is one reason Dr. Dold recommends surgery only after non-surgical treatment has been given a full chance.
Recovery after surgery
Most patients wear a sling or splint briefly, start gentle motion soon after, and begin strengthening over the following weeks. Return to heavy lifting or racquet sports usually takes a few months; Dr. Dold will give you a specific plan.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
- Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
- Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
Will tennis elbow go away on its own?
Often, yes. In a randomized trial, most patients in a wait-and-see group had improved at one year, although physical therapy helped them recover faster.2
Should I get a cortisone shot?
Cortisone relieves pain quickly, but symptoms often come back and long-term results can be worse than with no injection.5 Dr. Dold uses it selectively after discussing the trade-offs.
Does PRP work for tennis elbow?
Several randomized trials and recent meta-analyses suggest PRP provides more lasting relief than cortisone, but not every trial has shown a benefit.7,10,11
Does a tennis elbow strap help?
A counterforce strap can reduce pain during activity for some patients and is commonly used together with an exercise program.
How long does recovery take?
It varies. Many people improve over several months with exercise and activity changes; persistent cases may take longer.
When is surgery needed?
Only for the small number of patients who still have significant pain after at least 6 months of good non-surgical treatment.
Research cited on this page
- Shiri R, Viikari-Juntura E, Varonen H, et al. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164(11):1065-1074. PubMed
- Smidt N, van der Windt DA, Assendelft WJ, et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-662. PubMed
- Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil. 2014;28(1):3-19. PubMed
- Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. PubMed
- Coombes BK, Bisset L, Brooks P, et al. 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. PubMed
- Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. PubMed
- Gosens T, Peerbooms JC, van Laar W, et al. 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;39(6):1200-1208. PubMed
- 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. PubMed
- Krogh TP, Bartels EM, Ellingsen T, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013;41(6):1435-1446. PubMed
- Xu Y, Lin W, Qi Z, et al. Time-Dependent Efficacy and Safety of Percutaneous Treatments for Lateral Epicondylitis: A Systematic Review and Network Meta-Analysis. J Pain Res. 2026;19:604185. PubMed
- Krogh TP, Fredberg U, Stengaard-Pedersen K, et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41(3):625-635. PubMed
- Driscoll AM, Fucaloro SP, Mulvey M, et al. Complications of Platelet-Rich Plasma Injections for Lateral Epicondylitis Occur at Comparable Rates to Those of Corticosteroid and Saline Injections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthroscopy. 2026;42(5):935-946. PubMed
- Dold AP, Zywiel MG, Taylor DW, Dwyer T, Theodoropoulos J. Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. Clin J Sport Med. 2014;24(1):31-43. PubMed
- Kim JH, Hoy JF, Smith SR, et al. Recalcitrant Lateral Epicondylitis: A Systematic Review on Current Nonoperative and Operative Treatment Modalities. JBJS Rev. 2024;12(8). PubMed
- Dunn JH, Kim JJ, Davis L, Nirschl RP. Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med. 2008;36(2):261-266. PubMed
- Kroslak M, Murrell GAC. Surgical Treatment of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Am J Sports Med. 2018;46(5):1106-1113. PubMed
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. This page is general information, not medical advice. Individual results vary.
