Authors of a study in this week’s issue of THE LANCET conclude that steroid injections offer the best short-term treatment for tennis elbow, with physiotherapy offering marginally better long-term results than a ‘wait-and-see’ policy.
Tennis elbow (lateral epicondylitis) affects 1-3% of the adult population; symptoms usually last between 6 months and two years, with most patients making a full recovery. The condition is generally treated with corticosteroid injections or physiotherapy. However, Dutch clinical guidelines recommend a wait-and-see policy.
Nynke Smidt and colleagues from Vrije University, Amsterdam, Netherlands, studied patients with tennis elbow of at least 6 weeks’ duration who were recruited by family doctors. Patients were randomly allocated to 6 weeks of treatment with corticosteroid injections, physiotherapy, or a wait-and-see policy. Outcome measures included general improvement, severity of the main complaint (pain), elbow disability, and patients’ satisfaction. The severity of elbow complaints, grip strength, and pressure pain threshold were assessed; all outcomes were assessed at 3, 6, 12, 26, and 52 weeks.
185 patients took part in the study. Corticosteroid injections were substantially better than all other therapy options for all outcome measures at 6 weeks; success rates were 92% compared with 47% for physiotherapy and 32% for wait-and-see policy. However, recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy; success rates at 52 weeks were 69% for injections, 91% for physiotherapy, and 83% for a wait-and-see policy. However, the better success rate for physiotherapy over a wait-and-see policy was not statistically significant.
Nynke Smidt Comments: “Patients should be properly informed about the advantages and disadvantages of the treatment options for tennis elbow. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is small.”
Contact: Mrs Nynke Smidt, Institute for Research in Extramural Medicine, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands; T) +31 20 444 8180; F) +31 20 444 8181; E) n.smidt.emgo@med.vu.nl
Journal
The Lancet