New information has come out on what works and what doesn't work for lateral epicondylitis, aka tennis elbow. A new study published in the Journal of the American Medical Association will change how we have treated this condition for decades.
Being a tennis player myself, I have suffered from this condition. The outside elbow, where the lower arm tendon inserts on the epicondyle bone gets inflamed and swinging a racket or even lifting a carton of milk out of the refrigerator can cause excruciating pain. This is a very common condition and can be caused by any repetitive motion of that muscle. One of my patients got it from clipping roses. Traditionally the treatment is anti-inflammatory medication (ibuprofen, Aleve), ice and rest. For serious cases, physiotherapy and injection with a corticosteroid has always proved effective in my practice.
The researchers found, however, that patients treated with a single corticosteroid injection had a 14% greater chance of poor outcome and a 77% increased risk for re-injury at 1 year relative to placebo. Eight weeks of physical therapy appeared to have no long-term benefit with the exception of decreased analgesic use.
The researchers compared corticosteroid injection with placebo injection and found no difference at one year. The corticosteroid injection did reduce pain at four weeks compared to placebo injection. At 26 weeks that corticosteroid injected patients did worse than the placebo injection. Physiotherapy patients had better pain relief at 4 weeks but no difference at one year.
How can we explain these results? The decreased pain relief at 4 weeks may have allowed the patient to resume activity or engage in excessive activity before the healing was complete. Pain is the body's way of telling us to do something different.
The take home message here is that we need to be willing to change our treatment modalities as new evidence is presented. Lateral epicondylitis is a condition that will benefit short term from physical therapy and corticosteroid injections should not be done. As difficult as it is for a tennis player, resting the tendon and allowing the body to heal is the best medicine.
This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.