Tennis Elbow – steroid injection or not?
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Many people ask why they have this when they don’t even play tennis! Because it is an overuse condition, it can be brought on by many different actions, ranging from repetitive exercise, lifting at work or at home.
Some occupations are at a higher risk such as plumbers, carpenters and painters. With regards to tennis, forceful groundstrokes where the wrist is held still against an extended elbow puts strain on the forearm muscles. The same motion of wrist or forearm extension leads to inflammation of the tendons that attach the muscles to the bone on the outside of the elbow. Specifically the Extensor carpi radials brevis tendon or ECRB.
(image courtesy of OrthoInfo from AAOS, reproduced from The Body Almanac 2003)
When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain. As the tendon moves over the elbow during motion, it can also rub against the bone which leads to undersurface tears and worsening pain and inflammation.
Tennis elbow pain usually starts very mild and can be pin pointed to the outside of the elbow. As it worsens it can make the whole elbow feel painful and even a burning pain together with loss of grip strength. It is common for patients to have a tennis elbow strap which can improve their symptoms but when this stops working they are often advised to have a steroid injection.
The upcoming issue of the Journal of Hand Surgery(Am) has a strong meta analysis of studies comparing steroid injection against placebo (sham injection). Pain intensity was slightly lower 1 month, but not 3 months, after steroid injection. And when tested at 6 months after injection there was no difference between the steroid injection and the sham injection.
It is up to the individual patient and their Doctor as to the best treatment for their condition, but it certainly appears on this current evidence that steroid injections for tennis elbow do little to improve symptoms beyond 3 months.
For more details please click on this link. You can read the abstract but you will need a subscription for the full article.
