I'm trying to decide if I should have surgery for my tennis elbow. I've tried acupuncture, physical therapy, and the usual rest and antiinflammatories. Nothing seems to help. It's not worse, but it's not better either. What do you suggest?

There are no easy answers to this question. Since the cause(s) of lateral epicondylitis (tennis elbow) remain unknown, finding the best treatment has been difficult.

Most studies show that the majority of people are helped by conservative care. However, it can take up to a year or more for symptoms to resolve. For those patients who do not get better, surgery is another option.

Again, since the pathology behind tennis elbow is unknown, the best type of surgery is also a mystery. Arthroscopy is preferred by some surgeons. This type of operation allows the surgeon to see inside the joint. This ability makes it possible to treat any abnormalities that can be seen.

Other surgeons prefer to cut the soft tissue structures using a smaller incision. This is referred to as a percutaneous release. A smaller incision means less pain and faster recovery. But this method doesn't allow the surgeon to inspect the joint for other problems.

Your surgeon may be able to offer some insight specific to your case. Your history, symptoms, and lack of response to nonoperative care may point to the type of surgery that would be best for you.