Tennis Elbow Embolization in Manhattan, NYC

Quick Answer

Tennis elbow embolization is a catheter-based procedure that reduces blood flow to abnormal vessels around a chronically painful elbow tendon. Small early studies show large improvements in pain and function, but no randomized trials exist yet, so it is usually considered only after months of standard care have failed.

If the outside or inside of your elbow has hurt for months, you already know how much it gets in the way. Lifting a coffee cup, turning a doorknob, carrying groceries, typing, gripping a tool or a racquet: they all hurt. Most people with tennis elbow or golfer's elbow get better with time and simple care. A smaller group does not, and those are the people who start asking about newer options like elbow embolization.

This guide explains what elbow embolization is, what the research actually shows, who might be a reasonable candidate, and how it compares with the treatments you may have already tried. It is written by David Fox, MD, FACS, RPVI, a board-certified vascular surgeon who performs musculoskeletal embolization in Manhattan. We will be direct about what is known and what is not.

What tennis elbow and golfer's elbow really are

Tennis elbow (lateral epicondylitis) affects the tendons on the outside of the elbow. According to the American Academy of Orthopaedic Surgeons (AAOS), the tendon most often involved is the extensor carpi radialis brevis, which helps steady your wrist when your elbow is straight. Golfer's elbow (medial epicondylitis) affects the flexor-pronator tendons that attach to the bony bump on the inside of the elbow.

Despite the "-itis" in the names, AAOS describes tennis elbow mainly as wear and small tears where the tendon attaches to bone. Many patients with long-standing pain also have a patch of abnormal new blood vessels around the tendon. Those vessels matter for embolization, as you will see below.

Both conditions are common in working-age adults. In a Finnish population study of 4,783 people aged 30 to 64, about 1.3% had definite tennis elbow and 0.4% had golfer's elbow at the time of the exam, with the highest rates between ages 45 and 54. Smoking, obesity, and jobs that combine repetitive and forceful arm use were linked to higher risk. AAOS notes that painters, plumbers, carpenters, cooks and butchers get tennis elbow more often than the general population, and that most people who develop it are between 30 and 50.

For a closer look at symptoms, exam tests and imaging, see our guide to tennis elbow causes, symptoms and diagnosis.

The good news first: most tennis elbow gets better

Before talking about any procedure, it helps to know the natural course of tennis elbow, because it shapes every treatment decision.

AAOS states that approximately 80 to 95% of patients have success with nonsurgical treatment.
A 2022 meta-analysis pooled the placebo and no-treatment groups from 24 randomized trials (1,085 people). About 89% reported feeling much better or fully recovered at one year. Roughly half of those still struggling improved every 2.5 to 3 months.
That same analysis found that how long someone had already had symptoms did not change their odds of improving.

That last point is important. A frustrating six or nine months does not, by itself, mean your elbow will never settle down. It also means that any active treatment, including embolization, should be judged against the real chance that your elbow would improve anyway. We take that seriously, and you should expect any doctor you see to do the same.

Still, a minority of people stay stuck. In a population-based study from Minnesota, about 1 in 10 patients who still had symptoms at six months went on to surgery. Those are the patients for whom a less invasive option is worth discussing.

What elbow embolization is

Elbow embolization is also called transcatheter arterial embolization (TAE), transarterial microembolization (TAME), or elbow artery embolization. It is an image-guided procedure done through a tiny puncture in an artery rather than an incision in the elbow.

The idea comes from studies showing abnormal, overgrown small blood vessels around chronically painful tendons. Researchers believe these vessels travel with new nerve fibers that may help keep pain signals going. In the procedure, a doctor guides a very thin catheter through the arteries to the small branches feeding the painful area, confirms the abnormal "blush" of vessels on an X-ray dye image, and then injects microscopic particles to reduce blood flow to those abnormal vessels. The goal is to calm the abnormal vessels while leaving normal tissue alone. In the main tennis elbow study, MRI two years later showed no damage to bone, cartilage or muscle.

The procedure was pioneered in Japan by Dr. Yuji Okuno's group. In their published reports, the catheter was placed through the radial artery at the wrist under local anesthesia, and the treatment took about an hour. Many of the early studies used a temporary embolic agent (imipenem/cilastatin) that breaks down on its own. Other centers use other temporary particles or very small microspheres. The approach a given doctor uses can differ, so ask about it at your visit.

If you are curious how this fits with embolization elsewhere in the body, our embolization guide covers knee, heel, shoulder, hip and elbow procedures side by side. Elbow embolization is one part of our broader tendonitis embolization practice.

What the research shows so far

This is the part we want you to read carefully. The early results are encouraging, but the evidence is still small and early.

Tennis elbow (lateral epicondylitis)

2017 pilot study, 24 patients (Japan). People had pain for more than six months and had not improved after at least three months of standard care. Disability scores (QuickDASH, 0 to 100, lower is better) fell from 50.8 before treatment to 8.3 at three months and 2.7 at two years in the 22 patients who were followed. Abnormal vessels were found in every patient, and there were no major adverse events. MRI at two years showed improved tendon scores without bone, cartilage or muscle damage. According to a later systematic review, about 36% of these patients had a second embolization after six months.
2019 conference report, about 50 patients (same group). Similar improvements were reported out to two years. This was presented at a meeting, not published as a full peer-reviewed paper.
2018 Korean study, 13 patients (15 treated areas), including 7 tennis elbows and 8 shoulders. Pain improved meaningfully in 73% of treated areas at four months. Results were better when the X-ray dye image showed an obvious blush of abnormal vessels.

Golfer's elbow (medial epicondylitis)

The evidence is thinner. The main study is a 2022 Korean review of 10 patients (14 procedures). Twelve of the 14 procedures (85.7%) met the study's definition of success at six months, and the average pain score fell from 7.6 to 0.9 out of 10. There were no major complications. Beyond that, there are case reports and expert commentary. Our golfer's elbow embolization page goes through this in more detail.

What is missing

As of October 2026, we could not find any randomized or sham-controlled trial of elbow embolization. That matters a great deal for a condition that often improves without treatment. Systematic reviews in 2022 and 2023 both concluded that randomized trials are still needed. In the United States, a UCLA study (NCT05325242) is testing elbow artery embolization with microspheres under an FDA investigational device exemption. It is a single-group study with an estimated completion date at the end of 2027.

For a study-by-study breakdown, including how long results have lasted, read tennis elbow embolization research and success rates.

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

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This article is part of our Embolization Guide.

Who may be a candidate, and who should not have it

In the published studies, people treated with elbow embolization generally:

Had elbow pain for at least six months, often much longer.
Had moderate to severe pain that limited work, sport or daily tasks.
Had tried and not improved with standard care such as activity changes, physical therapy, bracing, medications or injections.
Had a diagnosis confirmed by examination, and often by ultrasound or MRI.

Embolization is generally not a good fit, or needs extra caution, if you have:

Recent elbow pain that has not had a fair trial of conservative care.
Pain mainly from another source, such as a pinched nerve in the neck, ulnar nerve irritation, elbow arthritis or a ligament tear.
An active infection, a bleeding disorder that cannot be corrected, significant kidney problems, or a serious allergy to X-ray contrast dye. These were exclusions in the UCLA trial.
Pregnancy.
Previous surgery on the same elbow (excluded in the UCLA trial; may still be discussed case by case).

Our candidate guide walks through these points in more depth.

See a doctor promptly rather than waiting if elbow pain follows a fall or a "pop," if the elbow is hot, red and swollen with fever, if you cannot bend or straighten it, or if you have new numbness, tingling or weakness in the hand.

How embolization compares with other treatments

No treatment for chronic tennis elbow is perfect, and the evidence for several familiar options is weaker than many people realize.

Option	What the best evidence shows
Wait, modify activity	Most people improve within a year, as noted above.
Physical therapy and exercise	Helped more than waiting in the first weeks in trials. By one year, results were similar to waiting.
Cortisone injection	Best short-term relief at six weeks, but more relapses. In a 2013 JAMA trial, 54% had a recurrence at one year versus 12% with placebo.
PRP or blood injections	A 2021 Cochrane review of 32 trials found probably little or no benefit compared with placebo injections.
Bracing	A small placebo-controlled trial found short-term benefit; older reviews could not draw firm conclusions.
Surgery	AAOS reports success in 80 to 90%. However, a small placebo-surgery trial found no added benefit from removing the damaged tendon.
Embolization	Promising results in small, uncontrolled studies. No randomized trials yet.

Each comparison has its own article:

For athletes, tradespeople and anyone whose income depends on grip strength, timing and recovery matter as much as the procedure itself. We cover that in elbow embolization for athletes and manual workers.

What the procedure and recovery are like

Elbow embolization is typically done as an outpatient procedure. Based on published descriptions, you can expect:

A review of your imaging and history, then numbing medicine at the access site, usually the wrist.
A thin catheter guided to the elbow arteries using live X-ray.
Dye pictures to locate the abnormal vessels, followed by slow injection of tiny particles.
Removal of the catheter, a pressure band on the wrist, and a period of observation before going home.

Afterward, some soreness at the elbow is common. In a large 2025 safety study of 431 patients treated for various joint problems, pain at the treated site lasting more than a week happened in about 6% to 22% depending on the particle used, and it was more common in the elbow than other joints. In the 2017 pilot study, average disability scores were already lower at one month and continued to improve through six months, so recovery is usually gradual rather than overnight.

Risks and side effects

Reported problems after elbow embolization have mostly been minor and temporary: soreness, bruising or swelling at the elbow or wrist, and occasionally reddish skin discoloration over the forearm. A 2023 systematic review of shoulder and elbow embolization found minor side effects in 27 of 143 patients (18.9%), all of which resolved on their own or with oral pain medicine. No major complications were reported in the published elbow series.

Those studies are small, though, and small studies cannot rule out uncommon problems. Any arterial procedure carries some risk of bleeding, artery injury, reaction to contrast dye, or particles reaching tissue they were not meant for. Our article on risks and side effects explains each of these honestly.

Insurance and your consultation in Manhattan

Coverage for elbow embolization is uncertain. Major insurers still treat many musculoskeletal embolization procedures as experimental; Aetna, for example, lists knee embolization for arthritis, the most studied version, as experimental or unproven. We did not find a major insurer policy that lists elbow embolization as covered. Our office checks your specific benefits before treatment. Details are in is tennis elbow embolization covered by insurance?

At a consultation, Dr. Fox will go over your history, examine the elbow, review imaging, and talk through whether embolization makes sense for you or whether another approach is a better next step. Our consultation guide lists what to bring and questions worth asking.

Fox Vein & Vascular is located at 1041 Third Avenue in Manhattan. Whatever you decide, the goal is the same: a clear, honest plan for an elbow that has been hurting too long.

Frequently Asked Questions

Is elbow embolization the same as a cortisone shot?

No. A cortisone shot puts medicine directly into the elbow area with a needle. Embolization works from inside the arteries, using a catheter placed through a small puncture, usually at the wrist, to reduce blood flow to abnormal vessels around the tendon.

How much evidence is there for tennis elbow embolization?

Early studies are encouraging but small. The largest peer-reviewed paper followed 24 patients for two years, and no randomized or sham-controlled trial has been published yet. Golfer's elbow has even less data.

Will I need more than one treatment?

Possibly. In the 2017 pilot study, about 36% of patients had a second embolization after six months. Dr. Fox will discuss how he decides whether a repeat procedure makes sense.

Does embolization replace physical therapy?

Not usually. Most experts see it as an option after standard care has failed, and continued strengthening exercises are often part of recovery afterward.

Can both elbows be treated?

Both elbows can be affected by epicondylitis. Whether and when to treat each side is a decision made with your doctor based on your symptoms and imaging.

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.