Comparing Surgical and Nonsurgical Outcomes of Tennis Elbow

Tennis elbow is a condition that causes pain on the outside of the elbow, typically caused by motions involving straightening of the arm. The goal of this clinical trial is to investigate whether early surgery leads to better outcomes than physical therapy and watchful waiting for tennis elbow (lateral epicondylitis) in adults. This study aims to answer the following questions: * Does earlier surgical intervention improve pain and function more than physical therapy and watchful waiting after one year? * How do symptoms and function compare between the two treatments over two years? * How often do people who start with physical therapy and watchful waiting end up needing surgery? Researchers will compare early surgery to physical therapy and watchful waiting to see which treatment works better. Participants will... * be randomly assigned to have surgery or to try physical therapy and watchful waiting. * have a physical exam and grip strength test at each visit. * answer questionnaires about their elbow pain and function. * attend appointments at the start of the study, and at 6 weeks, 3 months, 6 months, 1 year, and 2 years.