Steroid injection in tennis elbow

Corticosteroid injection in tennis elbow

• has very good results in short term use (six weeks) but the benefits do not persist beyond six weeks (1)
  
  
• hydrocortisone acetate mixed with local anaesthetic may be used, and of note long acting steroids should be avoided as there is a risk of skin atrophy
  
  
• long term effectiveness when compared to other conservative methods are uncertain and recurrences are more common with long term use
  
  
• repeating and repeated corticosteroid injections
  • has been reported that repeated injections (average 4.3, range 3 to 6 over 18 months) were associated with poorer outcomes - the suggestion is that steroid injections are more effective in acute and subacute tendonitis (duration <12 weeks) (2)
  • if considering repeating corticosteroid injections then "..injections may be repeated 2-3 times at the same site at 3-6 month intervals, if the previous response was positive" (3)

Notes:

• a systematic review of non-surgical treatment for tennis elbow, found a short-term benefit for corticosteroid injection, but no differences between injection, oral NSAID, or placebo at 12 months follow-up (4)

Reference:

• Orchard J, Kountouris A. The management of tennis elbow. BMJ. 2011;342:d2687
• Chesterton LS et a. Management of Tennis Elbow. Open Access J Sports Med. 2011; 2: 53-59.
• UK NHS Clinical Knowledge Summaries http://www.cks.nhs.uk/tennis_elbow (accessed May 15th 2018)
• Sims, S.E.G et al. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand. 2014; 9(4): 419-446.