Steroid injections do not provide long-term relief from tennis elbow

Randomized comparison of three interventions for tennis elbow: mobilization with movement and exercise, corticosteroid or wait and see

Physiotherapy or a 'wait and see' approach are both more effective in tackling tennis elbow than corticosteroid (steroid) injections, a BMJ study reveals today.

Researchers in Australia tested different treatments on three separate groups of patients with tennis elbow. One group of participants were allocated the 'wait and see' approach – they were reassured that the condition would eventually settle down and encouraged to wait. They were also given specific instructions on modifying their daily activities so to avoid aggravating their pain.

A second group were given a local corticosteroid injection and advised to gradually return to normal activities. The final group received eight treatments of physiotherapy of 30 minutes over six weeks and were taught home exercises and self-manipulation. The physiotherapy group also received a resistant exercise band and exercise instruction booklet. Each group's progress was measured at six weeks, and again after a year.

Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the 'wait and see' group.

However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group. The injection group also had the most reported recurrences, with 72% of participants' condition deteriorating after three or six weeks – which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow.

The research also found that the superior long-term effects of physiotherapy were replicated by the wait and see approach – at the end of the study participants in both the physiotherapy and wait and see group had either much improved or completely recovered.

The authors say that "the…poor overall performance of corticosteroid injections should be taken under consideration by both the patient and their doctor in management of tennis elbow."

The study findings also support the idea that tennis elbow is, in most cases, a self-limiting condition. They conclude that "patients with tennis elbow can be reassured that, in the majority of cases, they will improve in the long-term when given information and ergonomic advice about their condition."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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