University of Pittsburgh
Tennis elbow is a condition that causes pain on the outside of the elbow, typically caused by motions involving straightening of the arm. The goal of this clinical trial is to investigate whether early surgery leads to better outcomes than physical therapy and watchful waiting for tennis elbow (lateral epicondylitis) in adults. This study aims to answer the following questions: * Does earlier surgical intervention improve pain and function more than physical therapy and watchful waiting after one year? * How do symptoms and function compare between the two treatments over two years? * How often do people who start with physical therapy and watchful waiting end up needing surgery? Researchers will compare early surgery to physical therapy and watchful waiting to see which treatment works better. Participants will... * be randomly assigned to have surgery or to try physical therapy and watchful waiting. * have a physical exam and grip strength test at each visit. * answer questionnaires about their elbow pain and function. * attend appointments at the start of the study, and at 6 weeks, 3 months, 6 months, 1 year, and 2 years.
Lateral epicondylitis (tennis elbow) is a degenerative condition of the common extensor tendon at the lateral epicondyle, most commonly involving the extensor carpi radialis brevis (ECRB). Most cases resolve spontaneously or respond to conservative management within one year, and current standard care reserves surgery for refractory cases after an extended trial of conservative treatment, typically six months or longer. The optimal timing of surgical intervention has not been evaluated in a prospective, randomized trial. This study addresses that gap by enrolling patients with acute-to-subacut…
Inclusion Criteria: * Clinical diagnosis of lateral epicondylitis, defined by: * Lateral elbow pain reproduced by resisted wrist extension or resisted middle finger extension * Tenderness to palpation over the lateral epicondyle or common extensor origin * Symptom duration of at least 2 weeks and no more than 3 months at time of enrollment * Willing and able to comply with follow-up schedule and assigned treatment protocol * Able to provide written informed consent Exclusion Criteria: * Prior surgery on the ipsilateral elbow * Prior corticosteroid or biologic (PRP, autologous blood) in…
* Formal physical therapy: eccentric strengthening and stretching program for the wrist extensor musculature, supervised by a licensed physical therapist, for a minimum of 6 weeks * Activity modification counseling: avoidance of repetitive wrist extension, gripping, and forearm rotation activities that reproduce symptoms * Counterforce (lateral epicondyle) bracing during symptomatic activities * NSAIDs or topical anti-inflammatory agents
Patients randomized to surgery will undergo operative release and debridement of the common extensor origin within 6 weeks of enrollment. Surgical technique will be at the attending surgeon's discretion and may include open release and debridement of the ECRB, percutaneous release, or arthroscopic release and debridement. Surgical technique will be recorded as a covariate. All surgeries will be performed by fellowship-trained hand and upper extremity surgeons within the Surgery of the Upper Extremity Research (SUPER) Group. Postoperative rehabilitation protocols will follow standard institutional practice and will be recorded.
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