Pain at the lateral epicondyle and the extensor origin that is attributable to lateral epicondylitis can be successfully treated with a combined aponeurotomy of the supinator and the extensor muscles. This technique has been used at our institution for over 3 decades with good results. Aponeurotomy of the supinator decompresses the posterior interosseous nerve, whereas the extensor aponeurotomy relieves the stresses on the extensor carpi radialis brevis origin. We retrospectively reviewed a series of 56 patients clinically diagnosed with resistant lateral epicondylitis who underwent surgery by a single surgeon with our technique between 2002 and 2010. Patients experienced a subjective improvement in symptoms, visual analog pain score, and grip strength (Jamar II). Only 3% of patients experienced recurrence requiring further treatment.