One hundred cases of lateral epicondylitis among 97 patients were reviewed, and 84 patients were contacted for long-term follow-up. Patients participated in a structured nonoperative treatment regimen. Mean age of contacted patients was 49 years; mean follow-up was 2.8 years. Surgery was averted in 65 (75%) of 87 cases. Patients who achieved pain control after only 1 cortisone injection successfully avoided surgery 88% of the time, whereas those requiring multiple injections avoided surgery only 44% of the time. Eventual outcomes were similar, regardless of treatment type. Patients requiring multiple cortisone injections to alleviate acute pain have a guarded prognosis for continued nonoperative management.