Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trialBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38961.584653.AE (Published 02 November 2006) Cite this as: BMJ 2006;333:939
- Leanne Bisset, PhD candidate1,
- Elaine Beller, director of biostatistics2,
- Gwendolen Jull, professor3,
- Peter Brooks, executive dean4,
- Ross Darnell, statistician3,
- Bill Vicenzino, associate professor ()3
- 1 School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia 4072
- 2 Queensland Clinical Trials Centre, School of Population Health, University of Queensland
- 3 School of Health and Rehabilitation Sciences, University of Queensland
- 4 Faculty of Health Sciences, University of Queensland
- Correspondence to: B Vicenzino
- Accepted 24 August 2006
Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.
Design Single blind randomised controlled trial.
Setting Community setting, Brisbane, Australia.
Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.
Interventions Eight sessions of physiotherapy; corticosteroid injections; or wait and see.
Main outcome measures Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.
Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.
Conclusion Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.
Contributors LB was responsible for the recruitment and screening of participants, did baseline and follow-up outcome assessments, analysed data, and prepared the manuscript. EB assisted in the trial design and reviewed the manuscript. GJ and PB assisted in the NHMRC grant application and trial design and reviewed the manuscript. RD advised on the statistical design of the trial and in the data analysis and interpretation. BV, as chief investigator on the NHMRC grant, supervised the running of the project, cross checked the participants entering the trial, and supervised data analysis and preparation of the manuscript. BV is the guarantor.
Funding University of Queensland and the National Health and Medical Research Council, Primary Health Care Project Grant, Australia #252710.
Competing interests None declared.
Ethical approval Institutional research ethics committee.