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Steroid injections 'delay recovery of tennis elbow'

Corticosteroid injections should not be used for patients with tennis elbow as they are associated with worse outcomes for pain at one year, say researchers.

The study

Adults aged 18 years or older with tennis elbow for longer than six weeks were randomised to one of four treatment groups: corticosteroid injection, placebo injection, corticosteroid injection plus physiotherapy, placebo injection plus physiotherapy. Injections were given just once, while physiotherapy comprised eight 30-minute sessions over an eight week period, given to a standard treatment protocol. Patients were followed for one year.

The findings

Patients randomised to receive corticosteroid injection were 14% less likely to experience complete recovery at one year– defined by the patient on a six-point Likert scale – than those who had a placebo injection. Corticosteroid injection was also associated with a 77% greater risk of recurrence at one year compared to placebo. There were no significant differences between patients who received physiotherapy and those who did not for both complete recovery and recurrence at one year.

What does it mean for GPs?

The Australian researchers concluded that the evidence ‘does not support the clinical practice of using corticosteroid injection to facilitate active rehabilitation,’ noting that while physiotherapy was not effective for long-term outcomes, there was some benefit in the short-term when prescribed in the absence of corticosteroid injections.

Expert comment

Dr Louise Warburton, GPSI in musculoskeletal medicine in Shropshire: ‘This is an interesting study – previous work has demonstrated that corticosteroids produce only short term benefit and that physiotherapy seemed better. But with a high recurrence rate from injections and the effects of physiotherapy wearing off after one year, we are left with a management plan of short-term physiotherapy.’

JAMA 2013, available online 6 February

Readers' comments (3)

  • This paper merely confirms a leading paper in the BMJ about 3 years ago that altered my behavior in primary care. Faced with this information, the majority of patients still push for injection. Tennis elbow is an horrid condition. A day of fly fishing, and a quarter peal of bell ringing cured my problems after several months of pain on separate sides and occasions. Room for a novel research project ?

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  • The worrying thing for me is I had the same injection into my spine & it also had no affect at all , it does make you wonder how theses treatments come about & I'm speaking from an Aracnoiditus sufferer point of view , & we all know what cover ups go on there , it's food for thought many thanks for reading this M.

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  • Apt timing to recognise the complementary therapy Bowen Technique as having very good lasting results with lateral epicondylitis, as well as other joint issues that end up in my practice following unsuccessful long term relief from steriod injections. Addressing the whole body not just the area in pain is a useful starting point. Having just treated a Main Sunday paper Features Editor for Tennis Elbow/RSI writers arm expect more on this subject in the mainstream media.

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