AbstractBack ground : some people suffer from pain & tenderness at the elbow joint ,Tennis elbow is the commonest cause of this disorder which usually occurs where the extensor muscle arises form the lateral epicondyle of humerus . Tennis elbow in addition to its occurrence in all levels of tennis players , can occur in other sports or may be occupational. In this study we did not record any Tennis player because this sport is so limited in Nasiriyah .Objective: To evaluate the effectiveness of the Non – surgical treatment to obtain relief form pain and tenderness in comparison with the surgical measures(least invasive & least expensive)Methods: Between December 1999 – December 2001 . 131 patients with tennis elbow were treated with non - surgical modalities at Nasiryyah general hospital in Thi – qar. All patients assessed for general examination with special consideration for the elbow joint. Results: 82 patients were male , 49 were female. 88 patients had affection of Right elbow ,38 of Left Elbow , 5 bilateral .Recovery was obtained in 15 cases were treated with rest and non steroidal anti Inflammatory drugs, while recovery in other 33 cases required the use of physical therapy(ultrasound) in addition to rest and non steroidal anti inflammatory drugs. Local injection of steroid was performed in 83 cases to relive pain and tenderness. Non surgical treatment failed to relive the symptoms in 5 elbows only Conclusion: Non – surgical modalities can successfully relive the symptoms of the tennis elbow in most of the patients .The success of Non surgical treatment required rest , proper use of non steroidal anti – inflammatory drugs in addition to cooperation of the patients.