The relative merits of a watch and wait policy, physiotherapy alone, steroid injection therapy alone, and physiotherapy and steroid injection therapy combined, for the treatment of tennis elbow, were assessed using a prospective randomised controlled trial (RCT) of factorial design. Although RCTs comparing different treatment strategies for tennis elbow have previously been published, to our knowledge none of the previous studies have combined the modalities of physiotherapy and steroid injection as one of the treatment groups, as we have done in this study. Patients who received steroid injection were statistically significantly better for all outcome measures at follow up. No statistically significant effect of physiotherapy nor interaction between physiotherapy and injection was found. On the basis of the results of this study, the authors advocate steroid injection alone as the first line of treatment for patients presenting with tennis elbow demanding a quick return to daily activities.