Common treatments for tennis elbow or lateral epicondylalgia (LE) are frequently combined in clinical practice. The use of corticosteroid injection (CSI) to treat LE is increasingly discouraged due to the lack of long-term efficacy and due to high recurrence rates. In a randomized controlled trial with 1-year follow-up, recurrence was evident in 72% of patients receiving corticosteroid injection compared with 8% after physiotherapy.
A randomised placebo-controlled trial (Coombes et al. 2013) was conducted to investigate the effectiveness of CSI, multimodal physiotherapy, or both in patients with unilateral lateral epicondylalgia. Interventions consisted of CSI (n = 43), placebo injection (n = 41), CSI plus physiotherapy (n = 40), or placebo injection plus physiotherapy (n = 41). The results from this study found the use of CSI vs placebo injection resulted in worse clinical outcomes after 1 year. Physiotherapy in the absence of CSI was shown to provide short-term benefits across all outcomes, as well as the lowest recurrence rates (4.9%) and more complete recovery at one year follow-up (Coombes et al. 2013).
Take home message: based on the research and what we know today, it may be better to provide our patients with a course of hand therapy, which does not hinder recovery, and may facilitate return to function in clients with severe pain. Graded resistance training may be appropriate in the disrepair / degeneration phase of tennis elbow. During the acute phase, tendon unloading may be more appropriate through rest or splinting.
References available on request.