JEFFREY PENG MD
SPORTS MEDICINE & FAMILY MEDICINE
TENNIS ELBOW
TREATMENT IN SAN JOSE, CA
Tennis elbow — also known as lateral epicondylitis or lateral epicondylar tendinopathy — is one of the most common causes of elbow pain, affecting 1-3% of the general population with peak incidence in the 40s and 50s. Despite its name, it rarely comes from playing tennis. Any repetitive activity involving gripping, twisting, or extending the wrist — computer work, manual labor, gardening, cooking, sports — can lead to progressive degeneration of the common extensor tendon.
Dr. Jeffrey Peng is a board-certified sports medicine physician in Campbell, CA specializing in non-surgical treatment for tennis elbow — including PRP injections, percutaneous needle tenotomy, shockwave therapy, and targeted eccentric rehabilitation. A systematic review found that PRP produces outcomes comparable to surgery — without the incision, the risk, or the recovery time (PMID: 33957212).
What Is Tennis Elbow?
Tennis elbow is caused by repetitive overuse or overloading of the common extensor tendon on the outer (lateral) side of the elbow. We initially thought this condition was inflammatory — which is why it's still called lateral epicondylitis, with the "-itis" literally meaning inflammation. But we now have a much better understanding of what's actually happening at the tissue level: there are no signs of inflammation. Instead, what we see is tendon degeneration — tendinopathy.
Chronic repetitive stress causes the accumulation of microtears in the tendon. Over time, these microtears cause the tendon fibers to become thinned out, disorganized, and weaker. Normal, parallel collagen fibers are replaced by dense scar tissue and mucoid degeneration. Blood flow drops. The growth factors that drive healing are no longer present. The tendon becomes biologically stuck — unable to repair itself no matter how much rest you give it.
This distinction matters enormously for treatment. If tennis elbow is a degenerative problem (not inflammatory), then anti-inflammatory treatments like cortisone and NSAIDs aren't just ineffective for long-term healing — they may actually be counterproductive. What you need is to restart the healing process from scratch. This is exactly what PRP injections and percutaneous tenotomy are designed to do.
Symptoms of Tennis Elbow
Most of the time, there is no clear injury or single inciting event. The pain starts slowly and progressively gets worse. It centers on the outer (lateral) side of the elbow, right over the lateral epicondyle. You may notice pain when extending your wrist (especially against resistance), making a fist or gripping tightly, turning a doorknob or shaking hands, lifting objects with your palm facing down, or typing and using a mouse.
In severe cases, the pain can be present even at rest and can significantly limit your ability to work, exercise, and perform daily activities. Tennis elbow contributes significantly to lost days at work and decreased productivity — and the frustration of pain that just won't go away can take a real toll on quality of life.
Dr. Peng uses diagnostic musculoskeletal ultrasound to visualize the common extensor tendon in real time, identifying the degree of tendinopathy, any partial tearing, and calcifications — allowing for immediate diagnosis and a same-day treatment plan without the need for an MRI referral.
Non-Surgical Treatment Options for
Tennis Elbow
Targeted Rehabilitation — The Foundation
The foundation of tennis elbow treatment is a targeted rehabilitation program involving stretching and eccentric strengthening exercises. Daily stretching helps increase mobility and range of motion. Eccentric wrist extensor strengthening — slowly lowering a weight under control — reorganizes and remodels the tendon fibers and has the strongest evidence base of any conservative treatment.
Dr. Peng typically recommends starting with a structured exercise program for at least 4-6 weeks. The reality is that most people with tennis elbow will see significant improvement once they begin consistent rehab. But if symptoms persist or are severe from the start, more aggressive treatment is warranted.
Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) uses acoustic energy pulses to stimulate healing in the degenerated tendon. It promotes neovascularization, collagen synthesis, and pain relief. Shockwave is a reasonable intermediate step between rehabilitation and injection therapy for tennis elbow that has failed to respond to exercises alone.
PRP Injections for Tennis Elbow
Tennis elbow is one of the strongest indications for PRP in all of orthobiologics. The evidence base is deep, consistent, and growing — and it's the condition where PRP has arguably the most compelling data of any tendinopathy.
A brand-new randomized controlled trial (PMID: 40815854) followed over 200 patients with tennis elbow for 2 years, comparing PRP, physical therapy, prolotherapy, and shockwave therapy. The results were very clear: PRP patients had significantly greater functional improvement than the physiotherapy group — nearly double the gains. For context, PRP didn't just edge out physical therapy; the difference was clinically meaningful and substantial. Patient satisfaction followed the same pattern: PRP patients rated their outcomes 4.6 out of 5, while physiotherapy averaged only 3.0.
A separate systematic review of 26 studies (PMID: 35425843) found that PRP produced clinically meaningful improvements in pain and function from as early as 4 weeks through 2 years of follow-up — in both leukocyte-rich and leukocyte-poor formulations.
Why does PRP stand so far above other treatments? Because it addresses the underlying problem. PRP delivers a concentrated dose of your body's own growth factors directly into the damaged tendon. These growth factors signal tendon cells to produce new collagen, restore blood supply, and remodel tissue that's been stuck in a chronic degenerative state. Instead of just training muscles around the elbow or suppressing inflammation that's already gone, PRP provides the exact biological ingredients your tendon needs to actually repair itself.
PRP Produces Outcomes Comparable to Surgery
Perhaps the most striking finding: a systematic review (PMID: 33957212) directly compared PRP injections to lateral epicondylar surgery for the treatment of tennis elbow. The conclusion: "In comparison with surgery, PRP injections offer similar improvements in pain and function for patients suffering from lateral epicondylitis." PRP achieved equivalent outcomes to surgery — without an incision, without general anesthesia, without surgical risk, and with dramatically faster recovery.
Percutaneous Needle Tenotomy for
Tennis Elbow
For chronic tennis elbow that hasn't responded to rehabilitation, shockwave, or PRP alone, percutaneous needle tenotomy provides a minimally invasive option that directly addresses the damaged tissue. Using real-time ultrasound guidance, an FDA-cleared powered device mechanically fragments and removes the degenerated scar tissue and disorganized collagen that are preventing healing.
A meta-analysis (PMID: 37148349) of 35 studies and over 1,600 patients found that tenotomy significantly reduces pain at every time point measured — and the benefits compound over time, with long-term pain relief that continued to improve rather than fade. One of the most compelling long-term studies followed tennis elbow patients for up to six years after tenotomy and found that the procedure maintained pain relief and functional gains over the entire follow-up period.
Tenotomy Combined with PRP
Dr. Peng's preferred approach for stubborn tennis elbow combines tenotomy with PRP. Tenotomy clears out the damaged tissue and creates an acute wound environment; PRP then delivers concentrated growth factors directly into that freshly cleared space, amplifying the body's healing response. The entire procedure takes about 20-30 minutes in the clinic under local anesthesia. No incisions, no stitches, same-day discharge.
Insurance note: Most insurance plans, including Medicare, PPOs, and HMOs, cover the ultrasound-guided tenotomy portion. PRP is currently self-pay. However, tenotomy alone has strong standalone evidence (PMID: 37148349).
Why Dr. Peng Limits Cortisone for Tennis Elbow
Cortisone shots have long been the default treatment for tennis elbow. But the evidence against their routine use has been building for over a decade — and it's now overwhelming.
A landmark systematic review of 41 trials (PMID: 20970844) — published back in 2010 — found that while cortisone injections reduced pain in the short term, this effect reversed at intermediate and long-term follow-up. Patients who received cortisone actually did worse over time than those who received placebo. The researchers described this as "high-level evidence that cortisone injections are harmful in the long term for tennis elbow."
A more recent randomized controlled trial (PMID: 35867777) confirmed these findings: combining exercise with a cortisone injection did not improve outcomes over exercise alone. In fact, cortisone appeared to impair patient-reported outcomes at long-term follow-up compared to exercise therapy alone.
When compared directly to PRP, a 2025 meta-analysis (PMID: 40077872) found that cortisone provides better short-term pain relief (less than 2 months), but PRP provides significantly better long-term functional improvement and clinical pain relief. Dr. Peng may still use cortisone in very specific situations for acute flare management, but recommends transitioning to regenerative therapies for long-term outcomes.
Do I Need Surgery for Tennis Elbow?
Surgery for tennis elbow is rarely necessary. It is estimated that approximately 90% of all cases can be treated non-surgically. Surgery — typically involving debridement of the damaged ECRB tendon tissue through open, arthroscopic, or percutaneous techniques — is generally reserved for patients who have failed 6-12 months of conservative management.
But here's the key finding that changes the conversation: a systematic review (PMID: 33957212) that directly compared PRP injections to lateral epicondylar surgery found that PRP offers similar improvements in pain and function as surgery — without an incision, general anesthesia, or the 3-6 month surgical recovery timeline. Two of the three included studies showed PRP and surgery had equivalent outcomes; one study reported PRP and surgery had similar pain improvement and return to work rates.
This doesn't mean surgery is never appropriate. For the small percentage of patients who have failed all non-surgical options over an extended period, surgical debridement can provide relief. But given that PRP achieves comparable results with dramatically less risk and recovery time, Dr. Peng recommends exhausting non-surgical options — including PRP and tenotomy — before considering surgery.
Watch: Tennis Elbow Rehab Video
Dr. Peng breaks down a targeted exercise and rehabilitation program for tennis elbow.
Frequently Asked Questions
Frequently asked questions
Why Choose Dr. Jeffrey Peng for Tennis Elbow Treatment in San Jose?
Dr. Jeffrey Peng is a board-certified sports medicine and family medicine physician specializing in non-surgical treatments for sports injuries and orthopedic conditions. He completed his residency with the Stanford Family Medicine Residency Program and his sports medicine fellowship with the Stanford Primary Care Sports Medicine Fellowship in San Jose.
Dr. Peng has co-authored peer-reviewed research on platelet rich plasma with leading orthobiologics researchers and clinicians — no other PRP provider in the San Jose, Los Gatos, and Campbell area combines published research credentials with this level of clinical experience. He is an active faculty member training the next generation of sports medicine physicians and runs a popular YouTube channel with over 400,000 subscribers, making complex PRP research accessible to patients worldwide.
Every PRP injection is performed under real-time ultrasound guidance to ensure accurate placement into the targeted tissue. Studies show that ultrasound-guided injections are significantly more accurate than blind injections, which directly impacts treatment effectiveness.