Tennis Elbow Surgery vs. Alternative Treatment Options

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tennis elbow surgery vs. alternative treatments

I get asked all the time by patients, “Should I have surgery for tennis elbow?” So let’s delve into what tennis elbow is and whether surgery is a good idea or the dumbest mistake you’ll ever make. The good news is that in the second decade of the 21st century, you have a lot of options.

What is Tennis Elbow?

Tennis elbow is actually called lateral epicondylitis, which means that the bump on the outside of your elbow, which is where the muscle tendons that extend your fingers and wrist are attached, is irritated with small tendon tears. Research into this type of tendinopathy shows that the issue isn’t really swelling like we once thought, but is instead degeneration and small tears in the tendon.

You really can’t fully understand why you have tennis elbow before you understand a little bit about how the body works as one big machine, with the whole arm being a portion of that machine with specialized parts. Trying to consider only what’s happening at the elbow is like looking at your lone bald tire on your right front wheel and not considering the screwed up front end alignment that caused the problem. Your neck and shoulder complex are also part of the upper extremity machine, so any issues at the elbow must always include an examination of the neck and shoulder as well. If your orthopedic surgeon or some physician assistant only examines your elbow and then recommends care, it’s time to find a new doctor!

One of the more common things we see as a cause of tennis elbow is low level nerve irritation in the neck. This is because the nerves in the neck power the muscles that attach at the outside of your elbow. When the signals aren’t getting through, the muscles in your forearm don’t work properly and then they begin to yank too much at their attachment to the outside elbow bone. This leads to tennis elbow. What if you don’t really have a lot of neck issues? Take note, because your first warning sign that the neck nerves are being irritated or pinched may well be your tennis elbow.

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Tennis Elbow Treatment Options

Steroid Shots – Avoid These!

Before they consider surgery, patients with tennis elbow are commonly sent to physical therapy or given a prescription of NSAIDs like Motrin, Mobic, or Celebrex. When this doesn’t work, a steroid shot is usually offered, but there are some good reasons you should skip this treatment. While a steroid shot is a potent anti-inflammatory, it can kill off healthy tendon cells, making the tendon weaker in the long run. Studies have also shown that while it can help for a few months, the pain will come back stronger than before the shot after it wears off.

Tennis Elbow Surgery – Quickly Becoming a Thing of the Past

Surgery for tennis elbow commonly involves using a scalpel to cut “fenestrations” or small holes or lines into the tendon. The idea is that these injuries will cause healing. While at some level this makes sense, surgery rates for tennis elbow have been plummeting for years due to new treatments that are much less invasive and much better studied as being effective.

Platelet Rich Plasma – Our Recommended Treatment for Tennis Elbow

One of the most popular treatments that has passed the gold standard test of a large randomized controlled trial is platelet rich plasma injections. This involves the doctor taking blood from an arm vein, spinning it down to concentrate platelets, and then injecting those into the painful tendons. When compared to steroid injections, PRP was much more effective.

This brings us to the quality, concentration and delivery of PRP used for treating tennis elbow. In our experience, PRP that is amber color and largely free of red and white blood cells, is more effective than the red PRP, which causes a much bigger inflammatory response.

Receiving these injections under precise imaging guidance can make a big difference, since the doctor is also able to visualize the exact areas where small tears and place the cells directly into those spots. In addition, how your tissue responds during the injection can also be observed. Healthy tendon tissue is hard to inject into and won’t separate apart with an injection, whereas unhealthy and torn tissue will fly apart in injection. Watch the video to the right to get a better understanding of what we can see during a guided injection.

Other Treatment Options

Prolotherapy, which is the injection of a solution that’s more concentrated than your body’s tissues and that causes a brief inflammatory healing reaction, is effective in our experience. ESWT (Extracorpeal Shock Wave Therapy) is a treatment where the arm is immersed in a water tank and sound waves that disrupt tissue are aimed at the injured area. While shock wave therapy has been touted as effective, a recent randomized controlled trial didn’t show any benefit to the therapy. Physical therapy exercises and stretches may also be a good option for alleviating pain and restoring function.

When All Else Fails

Some cases are recalcitrant to PRP injections. In those instances, treating the irritated nerves in the neck can often be the key to ensuring success. Sometimes tendons may just be too injured and torn up to allow the healing effects of PRP to work well. In these rare cases, our experience has found that injecting the patient’s own bone marrow stem cells may help.

The upshot? Surgery for tennis elbow is becoming a thing of the past, which is a good thing considering the invasiveness of the procedure. Avoiding steroid shots that can injure the tendon cells is important. PRP is definitely the way to go considering the excellent research that supports this newer procedure that uses the healing power of your own body!

This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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10 thoughts on “Tennis Elbow Surgery vs. Alternative Treatment Options

  1. Donna Millar

    I had surgery for my tennis elbow nearly 7 years ago, 2 weeks ago it went again. I’m hoping that I will get a steroid injection from the doctor on the 31 October & it will work , if not can I get surgery again?

    1. Regenexx Team


      Generally speaking, neither the surgery, nor the steroid shots are good long term strategies. Please see: If you’d to see if we can help you avoid further surgery, please submit the Candidate form.

  2. Theodore

    I had PRP 5 years ago but I’m starting to get some pain again. I’m hearing more and more about stem cell therapy. What do you think about it?

    1. Regenexx Team

      Stem cell therapy using your own bone marrow stem cells has the greatest healing potential. It’s appropriate to treat many issues, and not others. What area are you thinking about having treated?

      1. Heather Martinez

        Well what if you have MDS (bone marrow cancer) and have severe tennis elbow because you certainly can’t use your own stem cells for healing so then what?? This is my issue and I am in severe pain..

        1. Chris Centeno Post author

          Heather, 95% stem cells are overkill for tennis elbow. Platelet rich plasma has been shown to be effective for tennis elbow in a large clinical trial. Hence, there should be no issues using your own platelets.

  3. Mike

    I have struggled with this condition for the past 8 months. MRI in June revealed a high grade partial tear (75%) at insertion origin. Surgeon is recommending full open surgery for repair but I have read that type of surgery does not have great outcomes and includes a long and painful recovery. With this type of tear are stem cells the most effective treatment? I am setting up a consult with a physician in the Colorado office even though I live in Milwaukee, WI. My left elbow is also beginning to give me problems. I am unable to work out, golf, fish or even type without pain. Any advice on what the best course is for this type of tear would be appreciated.

    1. Regenexx Team

      We’ll know once we have the opportunity to examine you what type of treatment is needed in your particular case. Please see: and

  4. Glory Evans

    I’ve had elbow tendinitis for a year my doctor gave me too cortisone shots but after 3 months the shot wear off I’ve was injured on my job my doctor said I might need surgery if the pain came back

    1. Regenexx Team

      We treat elbow tendinitis regularly. Unfortunately Cortisone shots are a net negative and studies have shown steroids can damage tendon cells and intensify tendinitis, break down cartilage, increase the risk of fractures, and much, much more. If you’d like to see if your issue would be a Candidate, please submit the Candidate form, or call 866 684 9919. Please see: and

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