Transcatheter Embolization for Lateral Epicondylitis (Tennis Elbow)
Alternative to repeated injections · Day case · No surgery · 70–80% improvement rate
🎯 What is lateral epicondylitis?
Lateral epicondylitis, commonly known as "tennis elbow", is a painful tendinopathy at the insertion of the lateral epicondylar muscles on the lateral epicondyle of the elbow. It affects both athletes and people performing repetitive professional movements.
Pain is located on the outer side of the elbow, sometimes radiating to the forearm, worsened by gripping, handshaking, or resisted wrist extension. It can become disabling and resistant to standard treatments.
⚡ Tennis elbow embolization at a glance — At a glance
In chronic lateral epicondylitis, abnormal blood vessels sustain inflammation and pain. Embolization blocks these micro-vessels, without surgery.
Criterion
Data
Indication
Pain persisting beyond 6 months despite rest, physiotherapy and injections
Anaesthesia / stay
Local — day case
Does not preclude surgery later
Tendon structure unaffected
Cost
Covered by French national health insurance at Cochin AP-HP — no out-of-pocket fees
Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.
🔬 How does embolization work?
In chronic epicondylitis, the tendon develops pathological new blood vessels (neovascularisation) accompanied by sensitive nerve endings. This neovascularisation sustains pain through a neurogenic inflammation mechanism.
Embolization selectively occludes these pathological micro-vessels by injecting calibrated microspheres (75–100 µm) into the anterior radial recurrent artery. By reducing abnormal blood supply, the substrate of chronic pain is eliminated.
📋 Indications
Lateral epicondylitis persisting for more than 3–6 months
Failure of at least 2 corticosteroid injections
Failure of well-conducted eccentric physiotherapy
Neovascularisation confirmed on Doppler ultrasound
Significant pain (VAS ≥ 4/10) affecting quality of life or work
🔧 The procedure
1
Pre-procedure workup: Doppler ultrasound of the elbow confirming neovascularisation, standard blood tests, stop anti-inflammatory drugs 5 days before.
2
Day case: arrive in the morning, leave the same day. Local anaesthesia at the wrist or elbow puncture site.
3
Selective arteriography under fluoroscopic guidance: hypersective catheterisation of the anterior radial recurrent artery branches feeding the pathological area.
4
Embolization: injection of calibrated microspheres into the pathological neovessels. Arteriographic control confirming occlusion.
5
Total duration: 45–90 minutes. 2–3 hours observation. Return home the same day.
🏥 Recovery
Mild elbow pain for 24–48h, treated with paracetamol
✅ Covered by French National Health Insurance (Assurance Maladie) · No extra fees · Cochin University Hospital AP-HP
❓ Frequently asked questions
In chronic lateral epicondylitis, abnormal new blood vessels develop and sustain inflammation and pain. Embolization blocks these micro-vessels through a catheter, under local anaesthesia, as a day case.
Patients with tennis elbow pain persisting beyond 6 months despite rest, physiotherapy and injections, who want to avoid surgery.
Most treated patients report meaningful pain reduction within weeks to a few months. It targets the pain mechanism rather than the tendon structure itself.
No. Embolization does not alter the tendon or the joint, so surgery remains entirely possible afterwards if needed.
Yes. At Cochin AP-HP (a French public hospital), this procedure is covered by national health insurance with no out-of-pocket fees. Please use our contact form.
🆕 New in the literature: 2026 review of musculoskeletal embolization
A narrative review published in October 2026 in CVIR Endovascular (Pelage JP, Aldalmani T, Geevarghese R, Zhang N, Jegonday MA, Berry G, Dohan A, Fohlen A, Grange S) sorts the indications of musculoskeletal arterial embolization by level of evidence. Hemostatic and selected tumour-related indications are established. Pain-directed embolization, including genicular artery embolization and embolization for tendinopathies, is performed as a stand-alone minimally invasive procedure targeting pathological neovascularity. Evidence remains heterogeneous: the authors stress careful patient selection, standardized outcome assessment and further comparative trials to define durability and clinical value. It covers embolization for chronic tendinopathies, the subject of this page.
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.
