Steroid Shots May Not Ace Tennis Elbow

Steroid Shots May Provide Short-Term Help, but Not Best in the Long Run

Reviewed by Louise Chang, MD on September 29, 2006
From the WebMD Archives

Sept. 29, 2006 -- Australian researchers may have figured out how to ace tennis elbow, the joint pain caused by overusing the arms and forearms.

Anyone can get tennis elbow, even if they've never picked up a tennis racket.

But tennis champ or not, anyone with this elbow ache wants to bench the pain as quickly and permanently as possible.

For immediate relief, steroid shots work best. But physical therapy or just waiting for the injury to heal trumps shots in the long run, according to the Australian researchers, including Leanne Bisset, a graduate student at the University of Queensland's School of Health and Rehabilitation Sciences.

The study appears in BMJ's Online First edition. BMJ was formerly called the British Medical Journal.

Trumping Tennis Elbow

Bisset's team studied 198 adults who had had untreated tennis elbow for at least six weeks.

Patients were 18-65 years old (average age: 47) and lived in Brisbane, Australia.

First, the researchers told participants how to adjust their normal activities to avoid worsening their tennis elbow. Then they split participants into three groups.


Patients in one group each got a steroid shot to the joint and were told to gradually resume their normal activities. Some got a second steroid shot two weeks later.

Patients in another group got eight half-hour physical therapy sessions over six weeks. They learned exercises to strengthen their arm and forearm muscles.

Patients in the third group were told to wait for the injury to heal on its own. They were assured that, in time, their injury would mend.

Those in this wait-and-see group were told to be as active as possible, using heat, cold, and braces if needed. They didn't get steroid shots or physical therapy.

Patients in all three groups used pain relievers if needed.

Road to Recovery

For a year, Bisset and colleagues followed the patients' improvement, pain-free gripping, and tennis elbow severity (as rated by an expert unaware of the patients' treatment).

After six weeks, the treatments ranked in the following order:

  • First place: steroid shots
  • Second place: physical therapy
  • Third place: wait-and-see.


But by the year's end, steroid shots had tumbled from first place and the underdogs had triumphed. The final scoreboard:

  • Tied for first place: physical therapy and waiting
  • Last place: steroid shots.

People in the steroid group had the highest recurrence rate, meaning they were the most likely to get tennis elbow again.

Too Much, Too Soon

Steroid shots swiftly relieve pain. But they may not provide a permanent fix. Steroid joint injections carry risk for joint damage if done too often, and joint infection.

After getting steroid shots, patients may have felt so much better they overdid activity, making re-injury more likely, the researchers note.

While physical therapy was more effective than waiting at six weeks, there was no difference between those two groups by year's end.

Physical therapy "has a superior benefit to wait and see in the first six weeks and to steroid injections in the long term and may be recommended over corticosteroid injections," Bisset's team writes.

"However," they continue, "patients with tennis elbow can be reassured that most cases will improve in the long term when [patients are] given information and ergonomic advice about their condition."

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SOURCES: Bisset, L. BMJ, Sept. 29, 2006; Online First edition. WebMD Medical Reference in collaboration with The Cleveland Clinic: "Arthritis: Tennis Elbow." News release, BMJ.
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