english.prescrire.org > Spotlight > Archives : 2015 > Epicondylitis (tennis elbow) and corticosteroids: less success than physiotherapy

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Epicondylitis (tennis elbow) and corticosteroids: less success than physiotherapy

A local corticosteroid injection gives short-term relief, but increases the risk of recurrence, in contrast to physiotherapy.

Patients suffering from epicondylitis, or "tennis elbow", generally experience pain around the outside of the elbow. The pain is generally moderate and is triggered by certain movements, but it can become intense and continual, restricting activity and reducing grip strength.

Epicondylitis is commonly caused by repetitive movements, or by lifting heavy loads, either occupational or sports-related. In general, the treatment of periarticular pain requires first of all decreasing the movements and possibly completely resting the joint, and sometimes taking non-specific analgesics such as paracetamol, or a nonsteroidal anti-inflammatory.

A local corticosteroid injection relieves around two thirds of patients at 4 weeks, but with frequent recurrences: for 5 patients out of 6, the epicondylitis continues on average longer than with a placebo. The corticosteroid injection exposes the patient to infections and tendon rupture. Repeated injections increase the risk of adverse effects.

With physiotherapy, around a third of patients seem to improve in the short term, without reducing or increasing the chances of healing within a year, but with few recurrences. The absence of any severe adverse effects means that it is worth trying physiotherapy first.

In the case of unbearable pain, the choice of local corticosteroid injection to treat epicondylitis should only be carried out on a patient who is well informed of the pros and cons.

©Prescrire 1 June 2015

"Epicondylitis and corticosteroid injection: fewer cures at one year" Prescrire Int 2015; 24 (161): 160-161. (Pdf, subscribers only).

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