Corticosteroid Injection Verses High Energy Extracorporeal Shock Wave Therapy for Lateral Epicondylitis

Inclusion Criteria: * All patients presenting to the WRNMMC orthopaedic hand surgery clinic for complaints of lateral elbow pain will be evaluated for inclusion in the study. Inclusions criteria will be: * Clinical diagnosis of lateral epicondylitis based on primary complaint of lateral elbow pain and either (a) tenderness over the lateral epicondyle with direct palpation, or (b) exacerbation of pain at the lateral elbow with resisted dorsiflexion of the wrist * Failure of previous trial of non-operative management of at least 4wks duration (to include rest/light duty, non steroidal anti-inflammatory drugs , physical/occupational therapy, home stretching regimen) Exclusion Criteria: * Age \<18yo * Pregnant or planning to become pregnant during study period (based on verbal questioning) * Steroid treatment (oral or injectable) within the previous 3mo * Diagnosis of ipsilateral compressive neuropathy * Allergy to Kenalog, lidocaine, or conductive ultrasound gel * Diagnosis of inflammatory arthropathy or rheumatoid conditions * Diagnosis of fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome, or other chronic widespread pain syndromes