Tennis Elbow Embolization Risks and Side Effects

Quick Answer

Reported side effects of elbow embolization have mostly been mild and temporary, such as a pain flare, bruising, swelling or skin redness, and no major complications were reported in the published elbow studies. Those studies are small, though, and general catheter risks like bleeding, artery injury and contrast reactions still apply.

Every medical procedure has risks, and elbow embolization is no exception. The good news from the published research is that reported side effects have mostly been mild and short-lived. The important caveat is that the research is small, so uncommon problems may not have shown up yet. This article walks through both sides so you can weigh them with Dr. Fox.

What the studies have reported so far

Here is a summary of safety findings from the elbow and closely related studies:

2017 tennis elbow pilot (24 patients): no major adverse events. MRI two years later showed no bone marrow damage, no obvious cartilage loss and no muscle wasting.
2022 golfer's elbow study (10 patients, 14 procedures): no major complications during follow-up.
2018 shoulder and elbow study (13 patients): one patient treated with microspheres developed reddish skin on the forearm.
2023 systematic review of shoulder and elbow embolization: minor side effects in 27 of 143 patients (18.9%), all resolving on their own or with oral pain medicine.
2025 safety study of 431 patients treated with temporary particles for joint and tendon problems: no severe adverse events. Pain at the treated area lasting more than a week was the main issue and was more common in the elbow.

A 2022 systematic review of musculoskeletal embolization also reported no major complications across included studies, while cautioning that the studies were too small to identify common or severe adverse events. Keep that in mind as you read on.

Common, short-term side effects

Pain flare at the elbow

The most common complaint is an increase in elbow pain for days after the procedure. In the 2025 study, pain lasting longer than seven days occurred in 7.1% of patients treated with imipenem/cilastatin, 22.1% with quick-dissolving gelatin particles, and 5.8% with resorbable microspheres. The authors noted this was more common in the elbow joint than elsewhere.

Bruising, swelling and tenderness

A 2026 case report described diffuse bruising, swelling, a temporary drop in function and more pain right after treatment, all improving within days. Some tenderness or bruising at the wrist puncture site is also common.

Skin color change

Small arteries near the elbow also supply the skin. If particles reach those branches, the skin over the forearm or elbow can turn red or blotchy. In the published cases this was temporary. Your doctor will watch for it.

For how these feel day to day, read what to expect during and after the procedure.

Less common risks of any arterial procedure

These risks come with catheter procedures in general rather than from elbow-specific studies. They are uncommon, but you should know about them:

Bleeding or a blood collection (hematoma) at the puncture site.
Injury to or blockage of the access artery, which can occasionally affect blood flow to the hand.
Reaction to contrast dye, ranging from itching or hives to, rarely, a serious allergic reaction.
Kidney strain from contrast dye, mainly a concern for people with existing kidney disease. The UCLA elbow trial excluded people with a creatinine above 2 mg/dL.
Infection at the puncture site.
Radiation exposure from the live X-ray used to guide the catheter.

Non-target embolization: the risk specific to this procedure

"Non-target" means particles reaching tissue they were not meant for. Around the elbow, that could mean skin, muscle, bone, or nerves. This is the reason doctors use very small catheters placed far into the branches that feed the painful area, and why many use temporary particles that dissolve over time. A 2023 review on embolic choice noted that the original temporary agent, imipenem/cilastatin, is a reserve antibiotic whose use is restricted in some countries, so several other agents are now used. Each has trade-offs.

The reassuring point is that in the 2017 pilot, two-year MRI scans showed no bone or cartilage damage and no muscle wasting. The less reassuring point is that only about two dozen patients had that scan. Ask Dr. Fox which particle he uses and why.

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

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This article is part of our Embolization Guide.

Steps that help lower the risk

Much of the safety of embolization comes down to preparation and technique. Things your care team typically does, and things you can do, include:

Reviewing kidney function, allergies and medications before the day of treatment.
Pre-medicating people with a history of mild contrast reactions when appropriate.
Placing the catheter as close as possible to the abnormal vessels, so particles go only where intended.
Injecting particles slowly and stopping once the abnormal blush fades on the X-ray image.
Checking the skin, hand color and pulse at the end of the procedure and before you go home.
Giving you clear written instructions and a number to call after hours.

Your part is just as important: follow the wrist care instructions, avoid heavy gripping until cleared, and call early rather than late if something seems off.

Who has a higher risk or should avoid embolization

People with significant kidney disease or a severe contrast allergy.
Anyone with an active infection or an uncorrectable bleeding disorder.
People who are pregnant or breastfeeding.
People with poor circulation to the hand, which may affect choice of access site.
Anyone with an allergy to the specific embolic material or, where imipenem is used, to related antibiotics.

Tell the team about all medications, especially blood thinners, and about any past reaction to dye or antibiotics. Our candidate guide covers who is a good fit.

The risk of it not working

Not every patient improves. In a 2018 Korean study, pain improved meaningfully in 11 of 15 treated shoulders and elbows (73%). In the 2017 pilot, about 36% of patients had a second embolization after six months. And because tennis elbow often improves on its own, small uncontrolled studies may overstate how much of the benefit comes from the procedure. That is not a safety risk, but it is a real consideration when you weigh time, effort and cost. Read more in research and success rates.

How the risks compare with other options

Other tennis elbow treatments have their own downsides. A 2013 JAMA trial found that people given a cortisone injection had a 54% recurrence rate at one year, compared with 12% after a placebo injection. AAOS lists infection, nerve and blood vessel damage, prolonged rehabilitation, loss of strength or flexibility, and the need for more surgery among the risks of tennis elbow surgery. Embolization's risks are different, not absent. Our main tennis elbow embolization page puts these side by side.

Seek care right away if you notice

A hand or fingers that are cold, pale, blue, numb or weak.
Bleeding at the wrist that will not stop with firm pressure.
Skin over the elbow or forearm that darkens, blisters or opens.
Fever, chills, or spreading redness and warmth.
Trouble breathing, facial swelling or widespread hives.
Pain that keeps getting worse instead of better after the first few days.

Learn how embolization is used in other joints in our embolization guide.

Frequently Asked Questions

Is elbow embolization safe?

In the published elbow studies, no major complications were reported and side effects were mostly mild and temporary. However, those studies are small, so rare risks cannot be ruled out.

Can embolization damage the tendon or bone?

This is a theoretical concern. In a 2017 study, MRI two years after treatment showed no bone marrow damage, cartilage loss or muscle wasting, but only about two dozen patients were scanned.

What is the most common side effect?

A temporary increase in elbow pain. A 2025 study found pain lasting more than a week was more common after elbow treatment than other joints.

Does the type of particle matter?

It may. In a 2025 study, rates of prolonged pain differed by particle type, from 5.8% to 22.1%. Ask your doctor which agent they use.

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.