Tennis Elbow Embolization vs. Surgery

Quick Answer

Embolization treats tennis elbow through a small artery puncture with no elbow incision, while surgery removes damaged tendon and typically needs a splint and 4 to 6 months before return to sport. Neither has been proven against a placebo, and the two have never been compared head-to-head.

If you have been told that surgery is the next step for your tennis elbow, it is natural to look for something less invasive. Elbow embolization is one option people ask about. This article compares the two as fairly as we can, including a point that surprises many patients: the evidence for tennis elbow surgery is weaker than its long history might suggest.

One thing to know up front: no study has compared embolization and surgery directly. Any comparison relies on separate studies of different patients.

Side-by-side overview

	Elbow embolization	Tennis elbow surgery
How it is done	Catheter through a small artery puncture, typically at the wrist; tiny particles reduce blood flow to abnormal vessels	Open or arthroscopic; damaged tendon tissue is removed and healthy tendon is often reattached
Incision at the elbow	None	Yes (one larger or several small)
Anesthesia	Local anesthesia in published reports, with or without light sedation	Varies by surgeon and technique
Same-day discharge	Typically	Usually, per AAOS
Early recovery	Soreness for days; no splint	Splint for about a week, per AAOS
Return to sport	No published standard; individualized	Usually 4 to 6 months, per AAOS
Best available evidence	Small studies without control groups	Several small trials, including one placebo-surgery trial
Can it be repeated?	Yes; about 36% had a second session in one study	Revision surgery is possible but more involved

What tennis elbow surgery involves

According to the American Academy of Orthopaedic Surgeons (AAOS), most tennis elbow operations remove diseased tendon and reattach healthy tendon to bone. Surgery may be done through an open incision on the outside of the elbow or arthroscopically with small instruments. AAOS says surgery may be recommended if symptoms do not respond after 6 to 12 months of nonsurgical treatment.

Recovery, as AAOS describes it, includes a splint for about a week, stretching exercises after the splint comes off, light strengthening around two months, and return to athletic activity usually 4 to 6 months after surgery. AAOS reports that surgery is considered successful in 80 to 90% of patients, while noting that some loss of strength is not uncommon. Risks it lists include infection, nerve and blood vessel damage, prolonged rehabilitation, loss of strength or flexibility, and the need for further surgery.

What the research says about surgery

High success rates for surgery come mostly from studies without a comparison group, the same limitation that applies to embolization. When researchers have tried to test surgery more rigorously, the picture changes:

Cochrane review, 2011. Five trials with 191 participants met the review's criteria. The authors concluded there was insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain.
Placebo-surgery trial, 2018. In an Australian study, 26 people with tennis elbow for more than six months were randomly assigned either to have the damaged tendon portion removed or to a sham operation (skin incision and exposure of the tendon only). Both groups improved, and there was no significant difference at any point up to 2.5 years. The study stopped early, so it is small, but the result is striking.
2023 commentary in the Bone & Joint Journal. Researchers argued that there is no evidence surgery is superior to continued nonoperative care or no treatment, and that the long-held idea of operating after a set period of failed conservative care should be reconsidered.

This does not mean surgery never helps. It means that surgery, like embolization, has not clearly proven itself against a placebo.

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This article is part of our Embolization Guide.

What the research says about embolization

The main tennis elbow study is a 2017 pilot of 24 patients in Japan. Disability scores fell from 50.8 to 2.7 (on a 0 to 100 scale) at two years in the 22 patients followed, with no major adverse events. About 36% of patients had a second embolization after six months. Smaller Korean studies support the trend, including a 10-patient golfer's elbow study. No randomized or sham-controlled trial has been published. You can read the full breakdown in research and success rates.

The time factor most people overlook

Tennis elbow tends to improve with time even when symptoms have dragged on. A 2022 meta-analysis of people receiving placebo or no treatment in 24 trials found about 89% were much better or recovered at one year, and the duration of symptoms did not predict who would improve. In a population study from Minnesota, about 1 in 10 people who still had symptoms at six months went on to surgery.

For any procedure, this means part of the improvement seen afterward may have happened anyway. It is also a reason not to rush into an irreversible step. While you weigh your options, keeping up a structured exercise program is low-risk and may help on its own.

Who might lean toward each option

Embolization may appeal if you:

Have had moderate to severe pain for many months despite good conservative care.
Want to avoid an incision, a splint and a long rehabilitation period.
Accept that the evidence is early and that a second treatment may be needed.
Have no reason, such as kidney disease or a severe dye allergy, to avoid contrast.

Surgery may be the better discussion if you:

Have a significant tendon tear or another structural problem that embolization does not address.
Have other elbow problems that may need surgical treatment at the same time.
Cannot have an arterial procedure for medical reasons.
Have already tried embolization without enough benefit.

Choosing embolization does not close the door on surgery later. In the published studies, it did not appear to damage the tendon or bone on two-year MRI, although that was checked in only a small group. Our candidate guide covers the selection criteria in more depth.

Making the decision

A good decision usually comes from getting more than one view. An orthopedic or sports medicine surgeon can tell you whether there is a structural problem that needs fixing. Dr. Fox, a board-certified vascular surgeon, can tell you whether your elbow shows the abnormal blood vessel pattern that embolization targets and whether you are a reasonable candidate. You can also weigh how each option fits with your work and family responsibilities.

Questions worth asking either specialist:

What exactly do you see on my imaging, and is there a tear?
What results do you expect for someone like me, and what is that based on?
How long until I can work, lift or play my sport normally?
What happens if this does not help?
What will it cost me after insurance?

Learn more about the procedure on our main tennis elbow embolization page, see how it compares with injection treatments in embolization vs. cortisone and PRP, or explore embolization for other joints in our embolization guide.

Frequently Asked Questions

Is embolization an alternative to tennis elbow surgery?

It can be an option to discuss before surgery for people whose pain has not improved with standard care. The two have never been compared in a head-to-head trial.

Does tennis elbow surgery work?

AAOS reports success in 80 to 90% of patients. However, a small 2018 trial found no difference between surgery and a placebo operation, and a 2011 Cochrane review found the evidence insufficient.

Can I still have surgery after embolization?

Yes. Embolization does not remove or cut tendon tissue, so surgery remains an option if needed.

Which has the faster recovery?

Embolization avoids an incision and splint, while AAOS says return to sport after surgery usually takes 4 to 6 months. No published standard exists for return to sport after embolization.

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.

Tennis Elbow Embolization vs. Surgery: How They Compare