Results from a placebo-controlled trial show that patients given corticosteroid injections for treatment of unilateral lateral epicondylalgia, or tennis elbow, have a worse outcome after 1 year than those treated with placebo.
The researchers, led by Bill Vicenzino (University of Queensland, St Lucia, Australia), also found that additional physiotherapy did not seem to significantly improve outcomes in those injected with corticosteroid.
"Use of corticosteroid injections to treat lateral epicondylalgia is increasingly discouraged, partly because evidence of long-term efficacy has not been found, and due to high recurrence rates," say Vicenzino and team.
As reported in JAMA, 43 patients with tennis elbow were assigned to receive a single corticosteroid injection (10 mg/mL of triamcinolone acetonide in a 1 mL injection), 41 placebo injection alone (0.5 mL of 0.9% isotonic saline), 40 corticosteroid injections plus physiotherapy, and 41 placebo injections plus physiotherapy.
At 1 year, the researchers assessed scores for complete recovery or much improvement and recurrence (improvement or recovery at 4-8 weeks, but not after). They found that significantly fewer patients treated with corticosteroids had much improvement or completely recovered than those treated with placebo, at a respective 84% versus 93% without physiotherapy and 82% versus 100% with physiotherapy. Similar results were observed at 26 weeks.
Recurrence at 1 year was also significantly higher in the corticosteroid compared with the placebo group, at 55% without and 54% with physiotherapy versus 20% without and 5% with physiotherapy, respectively.
"Contrary to our hypothesis and to a generally held clinical view, we found that multimodal physiotherapy provided no beneficial long-term effect on complete recovery or much improvement, recurrence, pain, disability, or quality of life, thereby not supporting the hypothesis that the combined approach is superior," write the authors.
However, they add that patients in the placebo group who received physiotherapy seemed to have the best overall outcomes, both for improvement and recurrence, suggesting that physiotherapy in the absence of corticosteroid injection should not be ruled out for treatment of tennis elbow.
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