Skip to content
Book Now

Tennis Elbow (Lateral Epicondylitis)

Image-guided tennis elbow treatment in Midtown Manhattan. PRP, ultrasound corticosteroid injection, and percutaneous tenotomy by Dr. Alex Movshis.

Book a Consultation
What to expect at your first visit

A 45-minute diagnostic consultation with Dr. Movshis. Review of any prior imaging (bring MRI, X-ray, or CT on CD or via portal). Physical exam and discussion of your history. A clear diagnosis and a treatment plan by the end of the visit.

If a procedure is indicated, it's typically scheduled within 1–2 weeks at the same office.

Book a Consultation (646) 290-6660

Tennis elbow — known medically as lateral epicondylitis — is one of the most common and most under-treated causes of elbow pain in adults. Despite the name, fewer than 1 in 20 cases occur in tennis players. The vast majority happen in office workers, tradespeople, weekend athletes, and pickleball players — anyone whose forearm tendons take repeated load from gripping, lifting, or wrist extension.

At Modal Pain Management in Midtown Manhattan, Dr. Alex Movshis combines a focused clinical exam, bedside ultrasound, and an evidence-based treatment ladder that leads with PRP (platelet-rich plasma) and percutaneous tenotomy — interventions that address the underlying tendinopathy rather than just suppressing inflammation. Most patients are evaluated, diagnosed, and (when appropriate) treated in a single office visit.

This page covers what tennis elbow actually is, how it is diagnosed, why PRP is the preferred first-line injection for most patients, and the full evidence-based treatment ladder we use to get patients back to gripping, lifting, working, and playing without pain.

What Is Tennis Elbow?

Tennis elbow is a tendinopathy — a chronic, degenerative injury — of the common extensor tendon at the lateral epicondyle of the humerus (the bony bump on the outside of the elbow). The most commonly involved tendon is the extensor carpi radialis brevis (ECRB), with frequent involvement of the extensor digitorum communis. Despite the historical name “epicondylitis” (which implies inflammation), modern histological studies show that established tennis elbow is primarily a tendinosis — disorganized collagen fibers, microtears, and abnormal blood vessel ingrowth — rather than active inflammation. This is why pure anti-inflammatory treatment (rest, NSAIDs, cortisone) often provides incomplete or short-lived relief, and why treatments that stimulate tendon healing (PRP, eccentric loading, percutaneous tenotomy) increasingly dominate the evidence base.

The classic patient profile is age 35–55 with repetitive forearm load — but tennis elbow is increasingly common in younger office workers due to mouse use, in pickleball and padel players (the fastest-growing racquet sport demographics), and in CrossFit and weight training enthusiasts who load the forearm in pronation.

Tennis Elbow vs. Other Causes of Elbow Pain

Lateral elbow pain has several possible causes that look similar on the surface but require different treatment. At Modal Pain Management we systematically rule out each one:

  • Tennis elbow (lateral epicondylitis) — pain on the outer elbow, reproduced by Cozen’s, Mill’s, and Maudsley’s tests; tenderness directly over the lateral epicondyle.
  • Golfer’s elbow (medial epicondylitis) — pain on the inner elbow involving the wrist flexor tendons. Same treatment principles, opposite location.
  • Posterior interosseous nerve syndrome / radial tunnel syndrome — pain about 3–4 cm distal to the lateral epicondyle (rather than directly over it), with deep aching that worsens at night; reproduced by resisted middle-finger extension and resisted forearm supination.
  • Cervical radiculopathy (C6/C7 nerve root) — referred pain from the neck into the lateral elbow and forearm; often misdiagnosed as tennis elbow when the pain pattern is atypical or persistent.
  • Lateral collateral ligament injury — instability with lateral pivot stress, usually after trauma.
  • Posterolateral elbow plica — inflamed synovial fold catching during elbow flexion-extension; less common but a real entity.
  • Synovitis or early osteoarthritis of the radiocapitellar joint — joint-line pain rather than tendon-attachment pain.

A focused exam plus bedside ultrasound resolves most of these on the first visit. MRI is reserved for atypical or refractory cases.

Diagnosis at Modal Pain Management

A first-visit tennis elbow evaluation at Modal Pain Management includes:

  1. Focused history — onset (acute vs. insidious), occupational and athletic exposures (mouse use, racquet sport, gripping demands), prior treatments and their effect, and any neck or hand symptoms that might suggest a different diagnosis.
  2. Physical examination — inspection, palpation of the lateral epicondyle and surrounding structures, range of motion, grip strength testing, and the three classic provocative tests (Cozen’s, Mill’s, Maudsley’s).
  3. Bedside ultrasound — visualization of the common extensor tendon to grade severity (mild tendinosis, moderate tendinosis with partial tear, full-thickness tear), identify calcifications, and assess for neovascularization. This determines both prognosis and the optimal treatment.
  4. Targeted imaging — X-ray if there is concern for a calcification or arthritis; MRI for atypical presentations or before considering surgery.

The single-visit diagnostic workflow is one of the main reasons patients with chronic, undifferentiated lateral elbow pain often achieve faster definitive answers at Modal Pain Management than through serial referral.

Persistent elbow pain that hasn't responded to rest and bracing? Book a tennis elbow evaluation with Dr. Movshis — same-week appointments at our Midtown Manhattan office. Or call (646) 290-6660.

Image-Guided Treatment Ladder

The evidence-based treatment for tennis elbow follows a structured ladder. Most patients move through it from top to bottom; some can start at a higher rung based on chronicity and ultrasound findings.

Step 1: Conservative Treatment (Weeks 0–6)

For most patients with acute or mild symptoms, the first 4–6 weeks emphasize load reduction and the start of structured eccentric exercise:

  • Activity modification — temporary reduction in gripping, lifting palm-down, racquet sport, and aggravating workplace tasks.
  • Counterforce brace placed approximately 1 inch (one finger-breadth) below the elbow during unavoidable load — this redistributes force away from the inflamed tendon insertion.
  • NSAIDs for short-term symptom control if you tolerate them (naproxen 500 mg twice daily for 7–10 days, with food).
  • Eccentric strengthening — slow, lengthening contractions of the wrist extensors using a 1–3 lb dumbbell (3 sets of 15, daily) or the Tyler Twist exercise with a FlexBar — has the strongest single-intervention evidence base for tennis elbow.
  • Workplace and equipment ergonomics — vertical mouse, ergonomic keyboard, racquet weight and string tension review, grip technique coaching.

About 60–70% of acute cases resolve with this approach within 6–12 weeks.

Step 2: PRP (Platelet-Rich Plasma) Injection — Preferred First Injection (Weeks 6–12+)

For patients whose pain persists beyond 4–6 weeks of conservative care, or for chronic tendinopathy on ultrasound, PRP injection is the preferred first injection in the modern evidence base. PRP uses a small sample of the patient’s own blood, processed in-office to concentrate the platelets, then injected directly into the damaged tendon under real-time ultrasound guidance. The growth factors released by the platelets stimulate genuine tendon healing rather than simply suppressing inflammation.

PRP takes longer to work than cortisone (full effect at 6–12 weeks, with a temporary increase in soreness in the first 1–2 weeks as the healing response begins), but multiple high-quality studies show 70–85% of patients with chronic tennis elbow achieve durable relief at 12+ months — substantially better long-term outcomes than cortisone. PRP is typically not covered by insurance and has an out-of-pocket cost, which we discuss transparently before scheduling.

Step 3: Percutaneous Tenotomy for Refractory Cases (Months 3–6+)

For chronic, refractory tennis elbow (>6 months) that has not adequately responded to conservative care and PRP, ultrasound-guided percutaneous tenotomy is the next step before surgical referral. This is a minimally invasive office procedure in which a small needle (or a dedicated tenotomy device) is used under ultrasound guidance to mechanically break up the disorganized scarred tendon tissue and stimulate a healing response. It is performed under local anesthesia in approximately 20 minutes and has a 70–80% durable success rate in chronic cases that have failed other treatments. Recovery typically takes 4–8 weeks.

When Cortisone Is Used

Corticosteroid injection is appropriate in selected cases — typically acute, severe pain where a patient absolutely must function in the next 2–4 weeks (a critical work or athletic event). Cortisone provides faster short-term relief but is associated with higher 6- and 12-month recurrence rates, and repeated cortisone injections can weaken the tendon. We use cortisone selectively rather than as a first-line treatment, and never repeat it in the same tendon within 3 months.

When Surgery Is Considered

Surgery (open or arthroscopic ECRB tendon release) is reserved for the small subset of patients (<5%) with chronic, severe tennis elbow that has not responded to 6–12 months of structured non-operative treatment including PRP and tenotomy. We coordinate referrals to NYC orthopedic upper-extremity specialists when surgery becomes appropriate — but the great majority of patients avoid this pathway.

Physical Therapy and Self-Care

Image-guided injection accelerates pain relief, but durable recovery requires addressing the underlying tendon and biomechanics. A targeted rehabilitation program for tennis elbow typically includes:

  • Eccentric wrist extensor strengthening — the cornerstone of evidence-based tennis elbow rehab. The Tyler Twist (FlexBar) or dumbbell eccentrics, progressed gradually over 6–12 weeks.
  • Forearm and grip strengthening progression — slow eccentric grip, then concentric grip, then dynamic grip as pain allows.
  • Shoulder and scapular stabilization — weakness in the rotator cuff and scapular stabilizers shifts load distally onto the elbow tendons; addressing this prevents recurrence.
  • Workplace ergonomic evaluation — mouse, keyboard, monitor height, chair position, vertical mouse trial.
  • Equipment review for racquet sport athletes — racquet weight, string tension, grip size; for golfers, club fitting and grip technique.
  • Self-care — counterforce brace during load, ice for 15 minutes after activity, gradual return-to-sport progression.

Most patients see meaningful improvement within 6–12 weeks of starting structured rehab combined with appropriate injection.

When to Seek Specialist Care

See a pain specialist for tennis elbow evaluation if any of the following apply:

  • Lateral elbow pain that has not improved with 4–6 weeks of activity modification, NSAIDs, and a counterforce brace.
  • Pain that is interfering with work, sleep, or daily activities (gripping a coffee cup, opening a jar, shaking hands).
  • Symptoms that have been present for more than 3 months despite home treatment.
  • A previous episode that resolved and has now recurred.
  • Pain that is atypical (located more than 3 cm distal to the elbow, worse at night, associated with neck symptoms or hand numbness) — these patterns suggest a different diagnosis that needs to be ruled out.

Red-flag symptoms — sudden severe pain after a “pop,” visible deformity, bruising, complete loss of grip strength, or numbness in the hand — require prompt evaluation rather than an outpatient tennis elbow workup.

Why Modal Pain Management for Tennis Elbow in NYC

Modal Pain Management is a focused, physician-owned interventional pain practice in Midtown Manhattan. Dr. Alex Movshis is dual board-certified in Anesthesiology and Pain Medicine, completed pain medicine fellowship training at NYU Langone, and is on staff at NewYork-Presbyterian and Lenox Hill Hospital. NPI 1942741160 — see our evidence and credentials page and the physician bio for full verification.

Three things differentiate tennis elbow care at Modal Pain Management:

  • Single-visit diagnosis with bedside ultrasound. A focused exam plus real-time ultrasound imaging of the common extensor tendon — at the consultation visit — eliminates the back-and-forth of separate imaging appointments and provides immediate clarity on the type and severity of injury.
  • PRP-first treatment philosophy. The evidence base for chronic tennis elbow now favors PRP over cortisone for long-term outcomes. We use PRP as the first-line injection for most patients and reserve cortisone for selected acute scenarios — with transparent up-front discussion of cost, expected timeline, and realistic outcomes.
  • Coordinated medical, interventional, and rehabilitation plan. We work directly with NYC physical therapists who specialize in upper-extremity tendinopathy and coordinate care so that injection benefits convert into durable recovery, not a temporary reprieve.

Office: 369 Lexington Avenue, Floor 25, New York, NY 10017. Same-week appointments available. Most major insurance accepted for diagnostic visits and corticosteroid injections — verify your benefits or call (646) 290-6660 and our team will check coverage for you. PRP and percutaneous tenotomy have associated out-of-pocket costs that we discuss transparently before scheduling.

Treatment Options for Tennis Elbow (Lateral Epicondylitis)

Your treatment plan will be customized based on your specific condition and goals.

Joint & Soft Tissue Injections

Ultrasound-guided PRP (preferred) and selective corticosteroid injection of the common extensor tendon

Learn More →

Trigger Point Injections

Address compensatory forearm and shoulder muscle pain

Learn More →

Nerve Blocks

Diagnostic blocks to differentiate radial tunnel / PIN syndrome from true tennis elbow

Learn More →

Physical Therapy

Eccentric wrist-extensor strengthening (Tyler Twist / FlexBar), grip progression, ergonomic correction

Learn More →
View All Treatments

Insurance May Cover Your Tennis Elbow (Lateral Epicondylitis) Treatment

We work with most major insurance providers. Let us verify your benefits before your first visit — at no cost or obligation.

Verify Your Insurance

Why Choose Modal Pain Management?

Mount Sinai Fellowship-Trained

Board-certified with fellowship training in interventional pain medicine at the Icahn School of Medicine at Mount Sinai.

In-Office Ultrasound & Fluoroscopy

Image-guided injections performed in-suite — no hospital referral, no waiting weeks for outside imaging.

Same-Site PT, Chiro & IV Therapy

Coordinated non-surgical care under one roof at 369 Lexington Avenue — physical therapy, chiropractic, and IV therapy all on site.

Non-Opioid by Design

Treatment plans built around interventional, regenerative, and rehabilitative care — not pills.

Frequently Asked Questions About Tennis Elbow (Lateral Epicondylitis)

There is no overnight cure — tennis elbow is a tendon injury, and tendons heal on their own biological timeline. The fastest evidence-based path to recovery combines four steps in the right order. (1) Confirm the diagnosis with a focused exam (Cozen's, Mill's, and Maudsley's tests) plus bedside ultrasound to grade the severity of the tendon injury — guessing extends recovery by months. (2) Stop aggravating activities for 2–4 weeks (gripping, lifting palm-down, tennis backhand, mouse-clicking with a heavy grip) and use a counterforce brace placed about 1 inch below the elbow during unavoidable load. (3) Begin a structured eccentric exercise program — slow, lengthening contractions of the wrist extensors using a 1–3 lb dumbbell, 3 sets of 15 daily — which has the strongest evidence base of any single intervention. (4) Add image-guided injection if pain persists beyond 4–6 weeks: PRP (platelet-rich plasma) is the preferred injection because it has the best long-term outcomes and addresses the underlying tendinopathy; corticosteroid injection provides faster short-term relief (1–4 weeks) but is associated with higher recurrence at 6–12 months and should be used selectively. For chronic, refractory cases (>6 months), percutaneous tenotomy (a minimally invasive, ultrasound-guided procedure that breaks up scarred tendon tissue) is the next step before surgical referral. Most patients who follow this sequence are substantially better within 8–12 weeks.

Five categories of activity reliably make tennis elbow worse and should be avoided or modified during the first 4–8 weeks of recovery. Heavy gripping with the palm down (pronation): avoid lifting groceries, heavy mugs, briefcases, dumbbells, kettlebells, and gardening tools with a palm-down grip — switch to a palm-up (supinated) grip whenever possible. Repetitive wrist extension under load: avoid backhand strokes in tennis, mouse use without forearm support, painting overhead, hammering, and tightening screws. Aggressive stretching of the inflamed tendon: static, painful stretching of the wrist extensors during the acute phase can worsen tendinopathy — eccentric strengthening (controlled lengthening contractions) is the correct exercise, not static stretching. Cortisone injections without image guidance and without addressing the cause: blind, repeated cortisone injections produce short-term relief but are associated with higher recurrence rates and tendon weakening over time. Premature return to sport: returning to tennis, golf, pickleball, or weight training before 80% pain-free function and full grip strength almost guarantees recurrence. Continue the modifiable activities of daily living, but actively offload the tendon during the inflammatory phase.

It depends entirely on what kind of squeezing you mean. During the acute, painful phase (first 2–4 weeks): traditional repetitive ball-squeezing — gripping a stress ball or tennis ball as hard as you can in quick repetitions — is generally not recommended. It loads the same wrist extensors that are already inflamed and tends to perpetuate the cycle. For longer-term rehabilitation, controlled grip strengthening is an important component of recovery, but it should be done with a slow, eccentric (lengthening) emphasis rather than fast concentric squeezes. Better evidence-based alternatives include the Tyler Twist exercise (slow eccentric wrist extension using a flexible rubber bar — FlexBar), eccentric wrist extensor exercises with a 1–3 lb dumbbell, and reverse forearm curls progressing to 5–10 lb as tolerated. The exception: very gentle, low-resistance grip squeezes (a soft therapy putty held lightly) can be useful for proprioception and circulation during the early phase, but only at a load that produces no pain. The single most important principle is that strengthening should always be progressive, slow, and pain-free — pain during the exercise is the signal to reduce load or skip that day.

Yes — the majority of tennis elbow cases resolve completely with appropriate treatment, but the timeline varies dramatically based on chronicity, severity, and how the condition is managed. Acute tennis elbow (symptoms less than 6 weeks) typically resolves within 6–12 weeks with a combination of activity modification, eccentric exercises, and a counterforce brace — most patients return to full function. Subacute tennis elbow (6 weeks to 6 months) may take 12–24 weeks and benefits substantially from image-guided PRP injection plus structured physical therapy. Chronic tennis elbow (>6 months) is more difficult and reflects established tendinopathy with disorganized tendon fibers rather than active inflammation — these cases often require PRP, percutaneous tenotomy, or in rare cases surgical referral. About 5–10% of patients develop persistent symptoms requiring multimodal treatment over 6–12 months. The biggest factor in achieving permanent resolution is addressing the underlying biomechanical cause (grip technique, racquet specs, ergonomic setup at work) — without that, recurrence is common even after successful injection. Untreated tennis elbow does sometimes "resolve" on its own over 12–24 months, but with significant pain and reduced function during that interval — most patients are unwilling to wait that long when targeted treatment can compress the timeline to 8–12 weeks.

For most patients, yes — but the answer depends on your timeframe and goals. Cortisone (corticosteroid) injection provides faster initial relief (often within 1–2 weeks), is covered by virtually all insurance, and is appropriate for short-term symptom control when a patient absolutely must function in the next 2–4 weeks. However, multiple high-quality randomized trials and meta-analyses show that cortisone is associated with higher recurrence rates at 6 and 12 months compared with PRP or no injection, and repeated cortisone injections can weaken the tendon. PRP (platelet-rich plasma) injection uses a concentrated preparation of the patient's own platelets to deliver growth factors directly into the damaged tendon, addressing the underlying tendinopathy rather than just suppressing inflammation. PRP takes longer to work (6–12 weeks for full effect, sometimes with a temporary increase in soreness in the first 1–2 weeks), but produces better long-term outcomes — multiple studies show 70–85% of patients with chronic tennis elbow have durable relief at 12+ months. PRP is often not covered by insurance and has an out-of-pocket cost, which we discuss transparently before scheduling. At Modal Pain Management, Dr. Movshis uses PRP as the preferred first-line injection for most patients and reserves cortisone for selected cases (acute, severe pain; short-term high-stakes function requirement).

Tennis elbow is primarily a clinical diagnosis confirmed by physical examination, with imaging used to assess severity and exclude alternative causes. The exam includes three classic provocative tests: Cozen's test (resisted wrist extension with the elbow extended and forearm pronated reproduces pain at the lateral epicondyle — the most sensitive and specific test); Mill's test (passive stretch of the wrist extensors with the elbow extended reproduces lateral elbow pain); and Maudsley's test (resisted middle finger extension reproduces pain — specifically isolating the extensor carpi radialis brevis). Tenderness on direct palpation of the lateral epicondyle is essentially universal. Bedside ultrasound — performed in our office at the time of consultation — visualizes the common extensor tendon, identifies hypoechoic areas of tendinopathy, partial tears, calcifications, and neovascularization (a sign of chronic disease), and is essential for grading severity and guiding injection. X-ray is obtained if there is concern for a bone spur or arthritis. MRI is reserved for atypical cases or when surgical referral is being considered. Other diagnoses we exclude on examination include cervical radiculopathy, posterior interosseous nerve entrapment, radial tunnel syndrome, and lateral collateral ligament injury — each of which can mimic tennis elbow and requires different treatment.

Tennis elbow and golfer's elbow are both tendinopathies — repetitive-strain tendon injuries — but they affect opposite sides of the elbow and involve different muscle groups. Tennis elbow (lateral epicondylitis) involves the wrist extensor tendons (primarily the extensor carpi radialis brevis, or ECRB) at the outer side of the elbow (lateral epicondyle of the humerus). Pain is on the outside of the elbow, worsened by gripping, lifting palm-down, and wrist extension activities. Despite the name, only about 5% of tennis elbow cases occur in tennis players — most happen in carpenters, mechanics, painters, plumbers, office workers (mouse use), gardeners, and pickleball or racquetball players. Golfer's elbow (medial epicondylitis) involves the wrist flexor tendons at the inner side of the elbow (medial epicondyle). Pain is on the inside of the elbow, worsened by gripping, wrist flexion, forearm pronation, and the throwing motion. Golfer's elbow is far less common (about a fifth as frequent as tennis elbow) and is seen in golfers, pitchers, javelin throwers, weight lifters, and people with repetitive forceful gripping or hammering motions. The treatment principles are similar — load modification, eccentric strengthening, image-guided injection (PRP preferred over cortisone for most patients), and percutaneous tenotomy for chronic cases.

Most acute cases of tennis elbow (less than 6 weeks of symptoms) resolve within 6–12 weeks with appropriate conservative treatment — relative rest, eccentric strengthening, counterforce bracing, and activity modification. Subacute cases (6 weeks to 6 months) typically take 12–24 weeks and frequently benefit from PRP injection paired with structured physical therapy, with most patients reporting substantial improvement within 8–12 weeks of injection. Chronic cases (>6 months) reflect established tendinopathy and may require 6–9 months of multimodal treatment including PRP, percutaneous tenotomy, and dedicated physical therapy — about 90% of these patients ultimately achieve durable relief without surgery. Untreated tennis elbow does sometimes self-resolve over 12–24 months, but with significant pain and functional limitation during that period; most patients seek treatment to compress the timeline. Recurrence within 1–2 years is common (10–25% depending on the study) when the underlying biomechanical drivers — grip technique, racquet specifications, workplace ergonomics, training load — are not addressed alongside the injection or rehabilitation. At Modal Pain Management, every treatment plan includes a structured return-to-activity protocol designed to minimize recurrence.

Ready to Start Your Pain-Free Journey?

Schedule your consultation with Dr. Movshis today.

Book an Appointment
★★★★★
5 out of 5 based on 72 reviews
View all reviews on Google →

"Dr. Moshiv is truly the best. I originally came to him for neck pain management and was immediately impressed by how consultative and thoughtful his approach is. He takes the time…"

★★★★★
Christina Lee4 months ago

"The best of the best! My cervical dystonia is cured and I get so much benefit from the PT and chiro. It’s so nice and convenient to have everything in one place. The staff are so…"

★★★★★
Emily Holtzman3 months ago

"I had a great experience at Modal Pain NYC. Dr. Alex was incredibly kind, professional, and attentive throughout my visit. He took the time to understand my back pain and worked…"

Modal Pain Management NYC
369 Lexington Ave, Floor 25
View on Google Maps →