Am I a Candidate for Tennis Elbow Embolization?

Quick Answer

You may be a candidate if outside or inside elbow pain has lasted at least six months, limits daily life, and has not improved with standard care such as exercise therapy, bracing or injections. Embolization is usually not appropriate for recent injuries, active infection, uncorrectable bleeding problems, significant kidney disease or pregnancy.

Elbow embolization is not a first step for tennis elbow. It is something people consider when months of sensible care have not worked and the pain is still shaping their days. If you are wondering whether you fit that picture, this guide lays out the questions Dr. Fox works through with every patient, based on how candidates were selected in the published studies.

The short version

You may be a reasonable candidate if all of these are true:

Your pain is on the outside (tennis elbow) or inside (golfer's elbow) of the elbow and has lasted at least six months.
The pain is moderate to severe and limits work, sport, sleep or everyday tasks.
You have given standard care a fair try, such as activity changes, a structured exercise program, a brace, and possibly an injection, without lasting relief.
Your diagnosis is clear on examination, and other causes of elbow pain have been ruled out.
You understand that the evidence is early and that the procedure may not work for you.

Each point is explained below. For an overview of the procedure itself, start with our tennis elbow embolization guide.

Why "six months" keeps coming up

The first full study of tennis elbow embolization, a 2017 pilot of 24 patients from Japan, enrolled only people whose symptoms had lasted more than six months and who had not improved with at least three months of conservative treatment. Their average symptom duration was 17 months. The UCLA study now underway (NCT05325242) requires at least six months of failed conservative care and a pain score above 4 out of 10.

There is a good reason for this caution. Tennis elbow often improves with time. A 2022 analysis of untreated and placebo groups in 24 trials found that about 89% of people felt much better or recovered by one year. Interestingly, the same analysis found that people who had symptoms longer were not less likely to improve. So passing the six-month mark does not mean you are out of options. It means it is reasonable to start a conversation about what comes next.

What counts as "trying conservative care"

Doctors and insurers often want to see that the usual treatments have been tried. In practice, that tends to mean some combination of:

Reducing or changing the activities that provoke pain for a period of weeks.
A physical or occupational therapy program, usually with progressive strengthening exercises.
A forearm (counterforce) strap or wrist brace.
Over-the-counter pain relievers, if they are safe for you.
In some cases, one or more injections.

You do not need to have tried every option. Some people are wary of repeated cortisone shots, and that is reasonable: AAOS advises that steroid injections should be used very sparingly for tennis elbow. Bring a list of what you have tried, for how long, and how it went. That history is one of the most useful things at your first visit. We compare these options with embolization in embolization vs. physical therapy and bracing.

Questions about your treatment options? Dr. Fox can help.

Book a Consultation

This article is part of our Embolization Guide.

Making sure it really is tennis or golfer's elbow

Embolization targets abnormal blood vessels around an irritated tendon. If your pain is coming from somewhere else, it is unlikely to help. Several conditions can look similar:

Nerve problems. AAOS notes that nerve compression around the elbow can mimic tennis elbow, and a pinched nerve in the neck can cause arm pain. On the inside of the elbow, the ulnar nerve runs right behind the bony bump where golfer's elbow develops, so tingling in the ring and little fingers deserves attention.
Elbow arthritis, which an X-ray can usually show.
Ligament injuries, especially in throwing athletes with inside-elbow pain.
Bursitis at the tip of the elbow.

Dr. Fox will examine the elbow and review any imaging you have. Ultrasound and MRI can show tendon damage and, sometimes, increased blood flow around the tendon. In a 2018 Korean study, patients whose X-ray dye images showed an obvious blush of abnormal vessels improved more often (9 of 10 treated areas) than those without one (3 of 5). That finding is from a small study, but it supports the idea that the procedure works best when the target is clearly there. Learn more in tennis elbow causes, symptoms and diagnosis.

Who should not have elbow embolization

Embolization may not be appropriate, or may need to be postponed, if you have:

A recent or acute injury such as a fall, a pop or sudden weakness. These need a different evaluation, sometimes urgently.
An active infection, in the arm or elsewhere.
A bleeding disorder that cannot be corrected.
Significant kidney disease, because the procedure uses X-ray contrast dye. The UCLA trial excluded people with a creatinine above 2 mg/dL.
A severe contrast dye allergy that cannot be managed with pre-medication.
Pregnancy or breastfeeding.
Active cancer in the area.

Previous surgery on the same elbow was an exclusion in the UCLA study. That does not automatically rule you out, but it changes the anatomy and the conversation, so be sure to mention it. If you take blood thinners, do not stop them on your own; the office will coordinate with the prescribing doctor.

Special situations

Diabetes

People with diabetes often want to avoid cortisone because it can raise blood sugar. A 2026 case report described embolization in a 61-year-old man with diabetes and tennis elbow who had side effects from steroid injections. He improved after a short period of increased pain, bruising and swelling. A single case does not prove anything, but the authors suggested diabetes may be a factor worth weighing in outcomes. Your overall health will be part of the discussion.

Golfer's elbow

Inside-elbow pain can be treated with embolization, but the evidence is thinner than for tennis elbow, mostly a single 10-patient study. See golfer's elbow embolization for the details.

Wanting to avoid surgery

Many candidates are people who have been told surgery is the next step. Embolization does not involve cutting the tendon, but it has not been compared directly with surgery in a trial. It is a reasonable option to discuss, not a sure way around an operation.

Questions to ask yourself before booking

How much is the pain limiting what I need or want to do?
Have I been consistent with an exercise program for at least several weeks?
Am I comfortable with a newer procedure that has promising but limited evidence?
Am I prepared for the possibility that I might need a second treatment? In the 2017 pilot study, about 36% of patients had a repeat embolization.
Do I understand that my insurance may not cover it?

If you answer yes to most of these, a consultation is a sensible next step. You can also read about embolization in other joints in our embolization guide.

When not to wait: get prompt medical care for an elbow that is hot, red and swollen, especially with fever, or for new numbness, weakness, or loss of motion after an injury.

Frequently Asked Questions

How long should I wait before considering elbow embolization?

Published studies generally required at least six months of symptoms and failure of standard care. Your doctor may weigh this differently based on how severe your pain is and what you have already tried.

Do I need an MRI before embolization?

Not always, but imaging is commonly used to confirm the tendon problem and rule out other causes. Dr. Fox will review any ultrasound or MRI you already have and let you know if more is needed.

Can I have embolization if I already had cortisone shots?

Yes. Many patients in the published studies had prior injections. Let the office know how many you had and when the last one was.

Am I too young or too old for this?

The 2017 pilot study included patients aged 34 to 66. Age alone is less important than your diagnosis, overall health and how the pain is affecting your life.

Keep Reading

Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.