The use of steroid injections and physical therapy for tennis elbow, lateral epicondylalgia, has been called into question in a number of small studies. Now, Australian researchers, Coombes et.al., have published the results of a randomized trial of steroid injection vs placebo, both plus or minus physical ltherapy, in a 2 x 2 matrix.
The results? The primary outcome of complete recovery or much improvement at one year significantly favored placebo over steroid injection (96% vs 83%) with or without PT. There was some short-term advantage to steroid injection with PT but this benefit disappeared or was reversed by 26 weeks.
This is perhaps not surprising if we take into consideration that the process is more of a degenerative tendinopathy rather than an inflammatory tendinitis. So steroids might exacerbate the situation.
So, as in many other areas in medicine, let’s not let our powerful desire to “do something” to please our patients get in the way of practicing good medicine backed by evidence and science. Stop injecting those elbows.
Marshall Kubota, MD
Coombes BK et al., Effect of corticosteroid injection, physiotherapy, or both in clinical outcomes in patients with unilateral lateral epicondylalgia: A randomized controlled trial. JAMA 2013 Feb 6; 309:461.