INTRODUCTION: Extracorporeal shock wave therapy (ESWT) and Ultrasound therapy (UST) is being used widely to reduce pain and disability in tennis elbow. AIM: To compare the therapeutic efficacy of ESWT and UST in management of tennis elbow. DESIGN: Prospective, randomised, single blind, clinical trial. METHODS: 60 patients with tennis elbow were randomised to receive ESWT and UST with 30 patients in each group. ESWT group received 6 sessions, 2 times in a week and UST group received 10 sessions, 3 times a week. Patients were assessed clinically before treatment, 1, 2 and 3 months following completion of treatment using Visual Analogue Scale(VAS), Disability of Arm Shoulder and Hand(DASH) and MAYO elbow performance score. RESULTS: Reduction in pain and improvement in functional outcomes were observed in both the groups, as assessed by VAS, DASH and MAYO elbow scores. The mean VAS scores were significantly better in patients treated with ESWT as compared to UST at 1 and 2 months (p<0.05) months follow up. Mean DASH scores in ESWT group were significantly better at every follow up (p<0.05) as compared to patient treated with UST. Mean MAYO elbow scores became statistically significant at 3 months (p=0.002) following completion of treatment with ESWT as compared to UST. CONCLUSION: 1. Both ESWT and UST causes reduction in pain and disability. 2. ESWT is more effective than UST.