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
