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Steroid shots for tennis elbow may hurt, not help

By Genevra Pittman

NEW YORK (Reuters Health) - Getting a cortisone injection won't cure tennis elbow any better than a drug-free saline shot, according to a new study - and it might actually slow recovery.

Researchers found that a few weeks after receiving the steroid shots, people reported less pain and disability than those who'd been given placebo injections. But a year later, the same patients lagged behind the placebo group in their likelihood of complete recovery.

"This absolutely confirms that steroid injections are not a good idea," said Dr. Allan Mishra, an orthopedic surgeon at Stanford University in Menlo Park, California.

"This is important, because people think that it's okay to get a cortisone injection (for tennis elbow), and it's not okay. It puts you at a disadvantage long term in terms of getting better," Mishra, who has studied tennis elbow treatment but wasn't involved in the new study, told Reuters Health.

The condition is caused by overuse of tendons in the elbow and typically treated with non-steroidal anti-inflammatory drugs, physical therapy and steroid shots.

Last month, a study from Denmark found neither steroid nor platelet injections improved pain and functioning among people with tennis elbow any better than saline shots, over a period of three months (see Reuters Health story of January 22, 2013 here: http://reut.rs/Wl9Ckw).

Researchers at the time cautioned that the study's follow-up period was short and the results might look different at six months or a year post-injections.

By following patients longer, the new report shines a light on the possible long-term tendon damage that can be caused by cortisone shots, Mishra said.

‘DOES NOT SUPPORT' STEROID SHOTS

Bill Vicenzino from the University of Queensland in Australia and his colleagues randomly assigned 165 adults with tennis elbow to one of four treatment groups: cortisone shots with physical therapy, placebo shots with physical therapy, cortisone shots without physical therapy and placebo shots without physical therapy.

After one year, there was no difference in people's improvement in pain or functioning based on whether they'd had the eight sessions of prescribed therapy.

Among those who'd received a cortisone shot, 83 percent reported they had completely recovered from tennis elbow by one year. That compared to 96 percent of those who'd received a placebo injection, according to findings published Tuesday in the Journal of the American Medical Association.

Symptoms were also more likely to come back after a cortisone injection. The research team calculated that one more person would have a recurrence for every two or three treated with steroids instead of a saline shot.

"This evidence does not support the clinical practice of using corticosteroid injection to facilitate active rehabilitation," the study team wrote.

Cortisone injections typically start at about $100.

Mishra said researchers are looking for better treatments to address what is causing tendon pain in the first place, such as weakening of collagen in the tendon. One possible option being studied by himself and others is so-called platelet-rich plasma injections, but "we're not quite there yet," he said.

Many cases of tennis elbow also go away on their own with time and basic stretching, Mishra added.

"I think home-based exercises are probably sufficient for treating this," he said. "You'd be better off with that than with a cortisone injection. That's what you should start with, because you might not even need physical therapy."

SOURCE: http://bit.ly/JjFzqx Journal of the American Medical Association, online February 5, 2013.

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