Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial

Abstract

Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow. Design Single blind randomised controlled trial. Setting Community setting, Brisbane, Australia. Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months. Interventions Eight sessions of physiotherapy; corticosteroid injections; or wait and see. Main outcome measures Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks. Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections. Conclusion Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.

Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

“…Overall improvement was defined as patient-rated ''complete recovery'' or ''much improvement'' on a six-point Likert global assessment scale [4], a 50% or greater reduction in baseline pain status, a three-point reduction in the baseline VAS score, a final pain score of 3 of 10 or less, or a final Roles-Maudsley score [30] of 1 or 2. The analysis of pain relief used scores from the 10-or 100-point VAS, self-reported pain status, and four-point Roles-Maudsley rating scale [30].…”

Short-term efficacy of joint and soft tissue injections for musculoskeletal pain: An interventional cohort study

“…A study comparing the effectiveness of physical therapy and CS injections, reported that CSs are superior in the short-term but physical therapy is superior in the long-term. [15,16] With regard to tennis elbow, Tonks et al [17] assessed the relative merits of a 'watch and wait' policy, physiotherapy alone, steroid injection therapy alone, and combined physiotherapy and steroid injection therapy, using a prospective randomized controlled trial design. After 7 weeks, patients who received steroid injections had significantly superior outcomes on all measures at follow-up.…”

Results of Operative Treatment of Lateral Epicondylitis

“…не воспалительный, а дегенеративно-дистрофический процесс [6]. Среди иностранных авторов довольно часто используют термин tennis elbow -«локоть теннисиста», отмечая, что значительное количество игроков в большой теннис страдают этим заболеванием [4]. …”