The value of two widely used treatments for tennis elbow is being questioned by Australian researchers. According to a study published in the Journal of the American Medical Association, the combined use of steroid injections and physical therapy to treat tennis elbow works no better than a placebo and does not improve long-term outcomes from the painful injury.
Chronic unilateral lateral epicondylalgia is an overuse injury where the outer part of the elbow becomes sore and tender. While commonly referred to as “tennis elbow,” the condition can also be caused by swimming and climbing, or through repetitive manual labor. The pain is felt when a person fully extends their arm.
Researchers said a single corticosteroid injection did provide pain relief for patients over the short term, but that may have more to do with the strong placebo effect of an injection.
“Use of corticosteroid injections to treat lateral epicondylalgia is increasingly discouraged, partly because evidence of long-term efficacy has not been found, and due to high recurrence rates,” wrote lead author Brooke K. Coombes, PhD, of the University of Queensland.
Researchers looked at 165 patients who had unilateral lateral epicondylalgia for at least six weeks. During the year-long study, they were given either a corticosteroid injection; a placebo injection; a corticosteroid injection plus physiotherapy; or a placebo injection plus physiotherapy.
The group receiving injections was advised to avoid activities that caused or provoked pain, and to refrain from performing strenuous activity for two weeks. A gradual return to normal activities was then encouraged to minimize potential recurrence.
The physiotherapy groups underwent eight 30-minute sessions of physical therapy on the elbow over an eight week period.
During the course of the study, patients rated their treatment at regular intervals using a 6-point scale, ranging from “complete recovery” to “much worse.”
After one year, 90 percent of the patients reported complete recovery or much improvement. However, in patients who received the corticosteroid injection, significantly fewer reported being completely recovered or much improved. Their pain levels also remained higher.
Over half of the patients treated with a steroid injection experienced a recurrence, which was substantially more than the placebo group.
“While high recurrence rates after corticosteroid injection have been previously reported, our current study provides evidence that it may be the effect of the medication and not merely a manifestation of the condition or the injection,” Coombes said.
Researchers said the group that received physical therapy and a steroid injection did get short-term relief from pain, but the combined treatments did not significantly improve their chances of recovery or prevent a recurrence of tennis elbow.
The group that had physical therapy alone had the lowest recurrence rate (4.9%) and 100% of the patients in the group reported a complete recovery or much improvement after a year.