Corticosteroid Injections for Tennis Elbow
TREATMENT OPTIONS FOR TENNIS ELBOW
R E S C U R
Steroid injections have some risks. They can cause increased pain and swelling in the area of injection. Cortisone reduces the body’s ability to fight infection, and it is always possible the injection itself can introduce infection. Some people can have an allergic reaction to the ingredients, and diabetics always need to be careful about corticosteroid injections as it can significantly increase blood sugar levels. In addition, some studies have indicated that injections can increase the risk of tendon rupture. In addition, some patients, especially those with darker skin, may experience skin discoloration or lightening. Some studies have indicated that corticosteroid injection can cause long-term degeneration of tendons. While the risk of complications is low, they are nevertheless real and potentially serious.
Smidt N, van der Windt DA, Assendelft W, et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet. 2002 Feb 23;359(9307):657-662.
Bisset L, Smidt N, Van der Windt DA, et al. Conservative treatments for tennis elbow do subgroups of patients respond differently? Rheumatology (Oxford). 2007;46(10):1601-1605.
Recent national guidelines have downgraded opinions regarding steroid injections from “recommended” to “not recommended” based on more recent scientific studies. While injections can reduce pain for a short time, their long-term risks no longer outweigh the benefits.
Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, Kong FL, Welle K, Jiang ZC, Kabir K. Injection therapies for lateral epicondylalagia: a systematic review and Bayesian network meta-analysis. Br J Sports Med. 2016 Aug; 50(15):900-8.
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral EpicondylalgiaA Randomized Controlled Trial. JAMA. 2013;309(5):461–469. doi:10.1001/jama.2013.129
SELF CARE: 0/5
You can’t do these injections yourself.
Injections are usually covered by insurance, but otherwise can range from about $100 to $300.
USEFULNESS (overall rating): 2/5
Corticosteroid injections (CSI) used to be the “go to” treatment for LET: it was generally quick, only hurt a little and produced good relief that could last for days or weeks. It was considered a “recommended” treatment by many national guidelines. That, however, has changed recently based on newer, better studies. CSI have shown good short term results, but poor long term results, and various studies have demonstrated that over the long term patients who received injections did worse than patients who did not receive the injection. A recent study in JAMA showed that about 83% of patients who get the injection were improved at the end of the year, which sounds good, but 96% of patients who get a placebo injection were better at the same time. It also showed patients who had the injection were more likely to have the problem return than those patients who did not get the injection.
The treatment involves injecting a small amount of corticosteroid, often with some numbing medication, into the area of where the tendon inserts onto the lateral epicondyle. Corticosteroids are very powerful anti-inflammatory drugs. Remember, it used to be thought tennis elbow was mostly an inflammatory condition, which we now know is not really the case. Nevertheless, on a short term basis, steroid injections do relieve pain.
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