Evidence Suggests a Rethink on Corticosteroid Injections
Tennis elbow affects 1-3% of the general population and 15% of workers in at-risk industries. Medical practitioners following an evidence-based approach will find little high-level evidence for treating tennis elbow. Bissett et al (2006) investigated the short term and long term efficacy of a physiotherapy intervention (elbow joint techniques and specific exercise) compared with corticosteroid injections and “wait and see”.
Patients who received a corticosteroid injection showed significantly better effects at six weeks. However, there were very high recurrence rates after six weeks (47/65 of successes subsequently regressed). This setback persisted until at least 12-month post-injection.
Physiotherapy was significantly superior to the “wait and see” group until the six-month review. Compared to the corticosteroid group, the long-term recurrence was significantly lower in the physiotherapy group. Participants who had physiotherapy also sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than the other groups.
Wait and See
“Wait and See”significantly lagged the physiotherapy group until the six-month review. Compared to the corticosteroid group, the long-term recurrence was significantly lower in the “wait and see” group. Long-term recurrence was similar to the physiotherapy group, but “wait and see” participants required additional treatment, such as non-steroidal anti-inflammatory drugs.
Physiotherapy combining elbow joint techniques and specific exercise had a superior benefit to “wait and see” until six months and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.