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05-02-2013 | General practice | Article

Steroids for tennis elbow ‘harmful’


JAMA 2013; 309: 461–469

medwireNews: Giving patients corticosteroid injections for tennis elbow does more harm than good, shows an Australian study published in the Journal of the American Medical Association.

Multimodal physiotherapy also proved disappointing long-term, but the authors say this is still worth prescribing because it can provide short-term improvements and also help prevent the problem recurring.

Among 165 adults with unilateral lateral epicondylalgia, those randomly assigned to receive the corticosteroid injection (10 mg/mL triamcinolone acetonide in a 1 mL injection plus 1 mL of 1% lignocaine) had a worse rate of complete recovery or being much improved at 1 year than those who received a placebo saline injection (83% vs 96%).

They were also 77% more likely to have had the problem recur at 1 year.

Overall, patients who received 8 weeks of physiotherapy (combining elbow mobilisation with movement and exercise) with or without steroid injection had no better rates of complete recovery or much improvement at 1 year (91% vs 88%) or recurrence (29% vs 38%), than those who did not receive physiotherapy.

Furthermore, the authors note, it had no impact on pain, disability, or quality of life.

Nevertheless, after 4 weeks of physiotherapy patients had four times the recovery or much improvement rates seen without physiotherapy (39% vs 10%) as well as significant reductions in pain and disability.

The short-term benefit, say Dr Bill Vincenzino (University of Queensland) and team, as well as the lowest recurrence rates (4.9%) and 100% complete recovery or much improvement at 1 year seen with physiotherapy in the absence of the steroid injection, means "physiotherapy should not be dismissed altogether".

medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Caroline Price, Senior medwireNews Reporter