For most of the twentieth century the charm supported a tidy model of Anglo-Saxon medicine in which elves were held to shoot invisible darts that lodged in the body and caused sharp internal pain, with elf-shot as a recognised diagnosis. The model was attractive because it explained the imagery directly and because it connected to later folklore in which prehistoric flint arrowheads were called elf-shot.
That reading has been substantially questioned. The objection is that the evidence for a systematic elf-shot aetiology is thinner than the model requires, that the Old English words for elves carry a wider range of meaning than the model allows, and that the charm's language of shooting may be figurative in the way that a sudden pain is a stab in modern English without anybody believing in a knife. Alaric Hall's study of elves in Anglo-Saxon England, published in 2007, set out the case for reading the vocabulary more carefully; Karen Jolly's earlier work on popular religion in late Saxon England argued that the charms are best read as a Christian vernacular tradition rather than as pagan remnants.
The atlas records the elf-shot reading as debated rather than as either fact or error. Both camps are live, both are arguing from the same small body of text, and the disagreement is genuinely about interpretation rather than about evidence either side lacks. What is not in dispute is that the charm names elves as a cause of illness. What is in dispute is what an eleventh century compiler meant by that.
Sources Elves in Anglo-Saxon England: Matters of Belief, Health, Gender and IdentityAlaric Hall with Popular Religion in Late Saxon England: Elf Charms in ContextKaren Louise Jolly