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Corticosteroid injections are a poor treatment for tennis elbow

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f748 (Published 06 February 2013) Cite this as: BMJ 2013;346:f748

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Expert opinion is already turning away from corticosteroids for tennis elbow in response to mounting evidence that the injections don’t work for long and encourage recurrences. The latest trial compared corticosteroid injections, multimodal physiotherapy, both, or neither in 165 Australian adults with lateral epicondylalgia (tennis elbow).

Those given a single injection of triamcinolone with 1% lidocaine were less likely to be much improved or recovered one year later than controls given placebo injections (83% (68/82) v 96% (78/81); relative risk 0.86, 99% CI 0.75 to 0.99). They were also more likely to have had at least one recurrence (54% (44/81) v 12% (10/81); 0.23, 0.10 to 0.51). The authors were more surprised to find that adults given eight weeks of physiotherapy were no better after a year than controls managed without physiotherapy (much improved or completely recovered 91% (73/80) v 88% (73/83); 1.04, 0.9 to 1.19). Physiotherapy had no discernible effect on long term risk of recurrence.

The two treatments seemed to interact in the shorter term. Both helped recovery up to four weeks but only when used alone. Physiotherapy reduced the short term effectiveness of steroid injections and steroid injections reduced the short term effectiveness of physiotherapy. Doctors should think twice before using corticosteroid injections to facilitate a more active early recovery, say the authors.

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Cite this as: BMJ 2013;346:f748