What criteria should I use to decide when to refer a patient with tennis elbow for specialist evaluation?

Criteria for referral of a patient with tennis elbow to a specialist (orthopaedic surgeon) include:

• The diagnosis is uncertain and requires confirmation, potentially using imaging such as ultrasonography or MRI.
• There is refractory pain or severe functional impairment affecting the patient.
• Symptoms persist despite 6–12 months of optimal management in primary care, including rest, analgesia, physiotherapy, and other conservative treatments.
• Consider referral if there is no response to initial treatment after 6 weeks, with reassessment and possible physiotherapy referral before specialist referral.

Surgical options such as debridement or tendon repair may be considered after specialist evaluation.

Patients should also be advised on self-management, workplace adjustments, and sources of information during primary care management.

These criteria are based on expert opinion and narrative reviews, supported by the BMJ best practice guide and CKS clinical practice recommendations.

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