Tennis Elbow Lateral Epicondylitis Therapy

Tennis Elbow Injection

Tennis Elbow Lateral Epicondylosis is not an inflammatory condition but is now considered to be microscopic tearing with formation of scar tissue in the attachment of the extensor carpi radialis brevis (ECRB) muscle at the outside of the elbow. (See Tennis Elbow Injury – What is Tennis Elbow? for more details)
This microtearing and repair response can lead to full-blown tearing and structural failure of the origin of the ECRB muscle. The picture opposite is taken from an arthroscopic surgery to the elbow showing the radio-humeral joint and the damaged ECRB tendon. (www.elbowclub.com)

Tennis Elbow Lateral Epicondylitis Therapy – Should I have an elbow injection?

If recommended by your specialist YES -
BUT in my opinion only after

1. you can fully straighten your elbow – see Elbow Injuries -Can You Straighten Your Elbow
2. you have a good stretch in your extensor muscles – see Tennis Elbow Lateral Epicondylitis Exercises – How to Stretch
3. you have tried a few weeks of a structured rehab program – at least these

AND you still have pain!

Injections for Tennis Elbow

• Local Anaesthetic
• Corticosteroid
• Autologous Blood
• Botulinum Toxin

1. Local Anaesthetic Injection

Your Doctor or specialist may inject local anaesthetic into your elbow. This is purely diagnostic and is used to decide if the common extensor origin (where the tendons attach to the humerus) is the sole cause of your pain or whether there are other factors involved.

2. Corticosteroid Injection

These drugs include Triamcinalone (intermediate acting), Dexamethasone and Methylprednisalone (long acting). Their mode of action includes a reduction of the inflammatory reaction of the small blood vessels and restricts the accumulation of white blood cells and the release other inflammatory triggers.

However, as I said in the opening paragraph, Tennis Elbow is not considered to be an inflammatory process!!

BUT these injections are clinically proven to be effective!!

There are either other chemical effects taking place with the drug or the reason is physical.
The physical factors can be quite significant. Good injection technique involves placing multiple droplets around the tendon – I was taught to think of injecting droplets around a sugar cube and trying to get the corticosteroid on as many surfaces as I could.
This obviously has a mechanical affect on the scar tissue and the surrounding tissues with multiple to-ing and fro-ing of the cutting edge of the needle in these tissues.
If you are considering an injection as a patient – let me reassure you (before you panic) that this is all done through one or perhaps two holes in the skin – it is all the same injection not many!!

The corticosteroid generally will not be injected into the body of the tendon itself as this is thought to contribute to possible rupture of the tendon.

If you are a Doctor or Pharmacologist and can help explain why anti-inflammatory injections work with a non-inflammatory condition then please leave a comment below or please E-Mail me at

and I will include your explanation here.

3. Autologous Blood Injection

Blood is a rich source of growth factors that can stimulate an influx of cells that repair damaged tendon (fibrocytes) and help growth of new blood vessels. These properties are able to stimulate a healing response in chronic degeneration of a tendon (tendonosis).
The little blood is taken from one of your veins just like a routine blood test and this is then injected directly into the tendon at the elbow. The results of the studies I have seen are impressive – the patients in the studies had problems for a long time and had tried physical therapy, bracing and corticosteroid injections with no success.
Picture from orthosupersite.com
A study in rabbits showed that injecting the blood directly into the tendon had no damaging effect on the structure of the tendon unlike corticosteroids so it is a safe procedure.

4. Botulinum Toxin Injection

Injection of Botox into the muscles has been the subject of a few tests recently. One study in China showed success while others in the UK have not. The Botulinum toxin paralyses the muscle for a period of a few months which produces some weakness which may be an issue.
“One possible explanation is that the paralytic effect of botulinum toxin forces the extensor group of muscles to rest for a period of two to four months, thereby allowing the tendon fibers close to the lateral epicondyle time to repair,” reports the Chinese study.

Conclusion

Both corticosteroid and autologous blood injections have been shown to be effective. Corticosteroid injections at the lateral epicondyle have been shown to significantly decrease pain scores in the early post-injection period. Autologous blood injections for lateral epicondylitis were described in 2003 and showed encouraging pain relief in two thirds of patients treated.

My advice is

YES – BUT only after

1. you can fully straighten your elbow – see Elbow Injuries – Can You Straighten Your Elbow
2. you have a good stretch in your extensor muscles – see Tennis Elbow Lateral Epicondylitis Exercises – How to Stretch
3. you have tried a few weeks of a structured rehab program – Tennis Elbow Exercises

Try the conservative management of your problem first.

Please leave a comment below

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