Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment. 
Treatment of tennis elbow is a problem.  We performed magnetic resonance imaging (MRI) examinations of 11 elbows in 11 patients who were referred to us with refractory tennis elbow.  Of the 11 elbows, 6 showed a high signal intensity focus on MRI T2 images in the tendon of the extensor carpi radialis brevis at the lateral epicondyle.  The other 5 elbows showed various abnormal findings on MRI.  The mean age of the 6 patients with a high T2 signal focus was 52.0 years, and the mean morbidity period was 25 months.  We performed enucleation of the granulation focus through a surgical approach without detachment of the tendon origin of the extensor carpi radialis brevis.  Pain was relieved and elbow function recovered in all 6 cases.  This study demonstrates that MRI is an important decision-making tool in the surgical treatment of this condition.  Enucleation of the granulation focus with high T2 signal has proved to be effective in 6 selected cases.