I've had an on-again/off-again problem with tennis elbow. My doctor tells me surgery is only advised when conservative care fails. But how much time should go by before we take this step?

Your physician's advice is consistent with current evidence-based clinical guidelines. Conservative care includes a wide range of possible treatment modalities. Non-steroidal anti-inflammatory drugs (NSAID) are recommended when there is an acute case of tendinitis or acute flare-ups that may occur from time to time.

Splints, braces, or special compressive bands around the forearm may be used during repetitive or aggravating motions. A physical or occupational therapist may work with you to identify modifiable risk factors. This can include an ergonomic review of your home or work site.

Changes in posture may be needed. Other therapy techniques such as spray and stretch for trigger points, cross transverse massage, and electrical stimulation may be used by the therapist. Before considering surgery, your surgeon may want to try corticosteroid injections. Up to three injections can be tried over a period of weeks to months.

If all efforts fail to relieve pain and improve function, then surgery may be the next step. Most experts recommend a minimum of a six-month trial of conservative care. In the case of symptoms that come and go, there may be aggravating factors that can be identified and eliminated.

The average patient waits 12 to 14 months before having surgery. Sometimes patients struggle with this condition for years before trying surgery. Researchers haven't been able to identify the optimal (best) time for surgical treatment. Even the most effective surgical approach remains a matter of debate.