Steroids for tennis elbow ‘not bad’

“Tennis elbow injections do ‘more harm than good’”, reports BBC News. The article was referring to steroid injections that are commonly used to treat the pain and inflammation associated with lateral epicondylitis (‘tennis elbow’).

The above was reported in the Behind the Headlines services from the NHS Choices website (click here).  The service examined the underlying evidence and concludes:

This is a well-conducted systematic review but does have some limitations, largely relating to the quality of the underlying evidence. The researchers detail some of these:

• Firstly, the evidence available to compare steroid injections with physiotherapy and with placebo was ‘heterogenous’ (the underlying studies had relatively different methods) and this affects the confidence that can be assumed in the summary results when such studies are pooled.
• Some of the subgroups for analysis were quite small for many there was only one study. There may have been only limited power to detect any significant differences due to the small sample sizes

The research demonstrates a short-term benefit of corticosteroids compared with doing nothing for pain related to tennis elbow, but that this particular treatment has no effect in the longer term. There is no conclusive evidence that the steroid injections ‘do more harm than good’ as suggested by the BBC News headline. Some of the studies favoured the treatments that the corticosteroids were being compared against. However, this was often in single-study results (not pooled results) and was not the case for all comparators.

An editorial that accompanies this article suggests, “today’s review might discourage clinicians from using corticosteroids in patients who are seeking medium-term and long-term cures”. It says the clinical implication here is that one corticosteroid injection is not helpful for elbow pain at 6 to 12 months, and that multiple injections do not improve outcomes. However, given the shortage of studies for some of these analyses, especially of alternatives to corticosteroid injections for tennis elbow, the short-term benefits may still be better than nothing for many patients. The editorial says that “there is no compelling evidence that any injection for tendinopathy is a magic bullet”.