Tennis Elbow Injections do ‘more harm than good’

Corticosteroid injections for tennis elbow could do more harm than good, reports the BBC News summarising a study in The Lancet published October 2010.

The BBC story continued “It found that injections reduced pain for the first few weeks, but made the condition worse in the long term.”
Brooke K. Coombes of the University of Queensland and his researchers analysed the treatment of tendinopathy in more than 2,600 patients from 41 previous studies.
Writing in The Lancet, the authors concluded: “Our systematic review challenges continued use of corticosteroid injections by providing strong evidence that they are worse in the long term than are most conservative interventions for tendinopathy.”

This was particularly true for the treatment of lateral epicondylitis, known as tennis elbow.

The research found that in treating tennis elbow, corticosteroid injection had a large effect on reduction of pain compared with placebo in the short term, from three to six weeks.
But treatment with injections over a longer period, from four to six months up to 12 months, was not found to be beneficial.
In fact, researchers found that it made the pain from tennis elbow worse.
See Tennis Elbow Lateral Epicondylitis Therapy – Injection for Tennis Elbow? for other types of injections.

Tennis Elbow Injections do No Harm

These conclusions are disputed on NHS Website
The research demonstrates a short-term benefit of corticosteroids compared with doing nothing for pain related to tennis elbow, but that this particular treatment has no effect in the longer term. There is no conclusive evidence that the steroid injections ‘do more harm than good’ as suggested by the BBC News headline. Some of the studies favoured the treatments that the corticosteroids were being compared against. However, this was often in single-study results (not pooled results) and was not the case for all comparators.
An editorial that accompanies this article suggests, “today’s review might discourage clinicians from using corticosteroids in patients who are seeking medium-term and long-term cures”. It says the clinical implication here is that one corticosteroid injection is not helpful for elbow pain at 6 to 12 months, and that multiple injections do not improve outcomes. However, given the shortage of studies for some of these analyses, especially of alternatives to corticosteroid injections for tennis elbow, the short-term benefits may still be better than nothing for many patients. The editorial says that “there is no compelling evidence that any injection for tendinopathy is a magic bullet”.

Tennis Elbow / Lateral Epicondylitis Exercises are Best

Experts say exercising the affected area is preferable.

Writing about the findings in The Lancet, Dr Alexander Scott and Dr Karim Khan from the University of British Columbia in Canada, recommend exercise as the best way to cure tendinopathies.

“Specific exercise therapy might produce more cures at six and 12 months than one or more corticosteroid injections.”
Dr Khan said: “It sounds old-fashioned but specific exercise programmes are better than rest.”
“Exercise stimulates the tendon to repair by stimulating the tendon cells to make new proteins.”
“Tennis elbow and other tendinopathies have been shown to be a failure of tissue, not a result of inflammation, so exercise is the right thing to do.”

Conclusions

Draw your own conclusions if you will.

If you want mine :
I think that the injections are useful for a few months
BUT they have to be given to patients who are going to work at their stretching and strengthening programmes.

I think this is the best approach.
I would go as far as to say that the patient should demonstrate that they are doing stretching etc before they are given the injection!
I believe this would greatly improve the results….

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