Sports Medicine
In the long run, steroid shots may do more harm than good for tennis elbow

THE QUESTION The burning elbow pain and weak grip of the condition nicknamed tennis elbow are often treated with steroid injections and physical therapy. How much do these treatments help?

THIS STUDY involved 165 adults, who averaged 50 years old and had lateral epicondylalgia, or tennis elbow, in one arm for at least six weeks. Participants were randomly assigned to one of four treatments: a corticosteroid injection with or without physical therapy, or a placebo injection with or without physical therapy. Physical therapy consisted of 30-minute treatments weekly for eight weeks, involving elbow manipulation and exercises, plus a daily at-home exercise routine. Participants were to refrain from strenuous activity for two weeks after the injection and then return to normal activity. People who had gotten a steroid injection fared worse in the year after treatment than those who’d been given a placebo, with fewer of them rated as completely recovered or much improved (83 percent vs. 96 percent) and more having a recurrence (54 percent vs. 12 percent). They also reported worse pain. Physical therapy was found to have no bearing on how people fared long-term. However, those who did not get a steroid shot but did have physical therapy reported short-term benefits, such as less pain in the first few weeks, and the lowest recurrence rate (about 5 percent).

WHO MAY BE AFFECTED? Adults with tennis elbow, an overuse injury that stems from inflammation of the tendons that connect muscles in the forearm to the outside of the elbow. Though racket sports are a common cause, other activities and occupations that involve repeated twisting of the wrist also can lead to the condition.

CAVEATS Some data came from the participants’ perception of their pain and recovery, which may not be as objective as a clinical measurement.

FIND THIS STUDY Feb. 6 issue of the Journal of the American Medical Association.

A popular treatment for tennis elbow may cause harm in the long term. (Sarah Howling/iStockphoto)

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Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.