Purpose The purpose of our study was to examine the result of lateral epicondylitis surgery with and without posterior interosseous nerve release. Methods We conducted a prospective, randomized, double-blind single-center clinical trial in 54 patients treated surgically for lateral epicondylitis, without any EMG or imaging sign of compression of the posterior interosseous nerve at the arcade of Frohse. The patients were equally divided into intervention (supplemental radial nerve release) and control groups (no radial nerve release). Clinical symptoms and disability related to the upper extremity were assessed by a blinded assessor prior to surgery, using both the Quick Disabilities of the Arm, Shoulder, and hand ( Quick DASH) and Mayo Elbow Performance Score (MEPS) and again at 1-, 3-, and 6-month intervals after surgery. Results Significant improvement was observed in both groups from the first month after surgery and for the whole evaluation period for both the MEPS and the QuickDASH scores. Conclusions Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. Type of study/level of evidence Therapeutic I.