Background Conventional ultrasonography or magnetic resonance (MR) imaging is commonly performed to obtain information about the severity of the disease,location of the injury,and differential diagnosis.The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.Methods A single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients (9 men,19 women; mean age,48.5 years; age range,36-67 years) with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls.Greyscale images were described as normal,tendinosis,partialthickness tear,and full-thickness tear.Sonoelastographic images of the common extensor tendon were analyzed qualitatively (scoring of the elastic spectrum) and quantitatively (based on a color histogram).Results Both the imaging methods had high sensitivity,specificity,and accuracy for diagnosing lateral elbow tendinopathy.Considering the clinical diagnosis of lateral elbow tendinopathy,sonoelastography showed significantly higher diagnostic accuracy (96.4％) than ultrasonography (89.5％,P ＜0.01).Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows (P ＜0.01).Conclusion Sonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.