Cortisone Shots: Bottom Line
As welcome as the injections are, Vicenzino says skipping the injections appear to be a reasonable option when you consider recovery rates and the chance of recurrence.
"If we look at delaying recovery and [at] recurrence rates, then there is solid evidence, especially for the tennis elbow steroid injections, that they will delay recovery and there will be a high probability of recurrences beyond that if the patient had just adopted a wait-and-see policy [over 12 months]."
While the new non-steroid injections are becoming more popular, Vicenzino says many questions remain about them.
One of them, sodium hyaluronate, ''demonstrated vastly superior results across all time points," he says, and he believes that one should be further studied.
Whatever the injection that may be used, he says, it's not enough. The tendon needs to be ''mechanically stimulated" through exercise or physical therapy, he says, to address the disruption in collagen and at a cellular level that occurs with the tendon injury.
Shots for Tendon Problems?
''Chronic tendon injuries are not easy to treat," says John DiFiori, MD, team physician for the University of California Los Angeles Department of Intercollegiate Athletics and chief of sports medicine at UCLA's David Geffen School of Medicine.
One chronic tendon injury is not the same as another, even within the same tendon, he says.
"Cortisone injections can provide short-term pain relief, this study confirms that further," says DiFiori, who reviewed the study for WebMD.
The study findings, he says, suggest that patients "need to be cautious if their physician is recommending an injection and nothing more or multiple injections of corticosteroids," he says.
Agreeing with Vicenzino, DiFiori says that the physical therapy part of treatment is crucial.
''With these tendon injuries you are trying to heal the tendon, trying to get the tendon to be stronger," he says.
Of the newer, non-corticosteroid injections, he says: ''There is not enough data to recommend them."
In a comment accompanying the study, Alexander Scott and Karim Khan of the University of British Columbia point out that the evidence for exercise therapy ''is more encouraging than the evidence for corticosteroid injection."