Physiotherapy was more effective in the long term treatment of Tennis Elbow than corticosteroid injections.
Lateral Epicondylitis or Tennis Elbow as it is known is one of the most commonly diagnosed elbow conditions. It is characterised by a localised pain that can be felt over the lateral epicondyle or lateral aspect of the elbow. This lateral elbow pain is often reproduced with resisted extension of the wrist or middle finger extension and gripping.
Tennis Elbow usually develops over time with the most common cause being repetitive hand movements while gripping, using a computer etc. Currently the two most common options for the management of Tennis Elbow are physiotherapy and corticosteroid injections. The following study compared these two treatment options and their effectiveness over the period of a year.
There is no agreement for the effectiveness of any one non operative management technique over another for managing Tennis Elbow. Kucuksen et al (2013) conducted a randomised control trial to compare use of muscle energy techniques and corticosteroid injections to determine the short- and long-term effectiveness of the muscle energy technique (MET) compared with corticosteroid injections (CSIs) for chronic Tennis Elbow. Eighty two patients with chronic Tennis Elbow were randomly assigned to two groups. Group 1 received either 8 sessions of MET and group 2 received one CSI. Grip strength, pain intensity, and functional status were assessed using the pain-free grip strength (PFGS), a visual analog scale (VAS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, at 6, 26, and 52 weeks.
Results showed that at 52 weeks, there was statistically significant improvement in both groups of Tennis Elbow patients. The patients who received a CSI showed significantly better effects at 6 weeks according to the PFGS and VAS scores, but after this 6 week period these improvements did not last. At the 26- and 52-week follow-ups, the patients who received the MET were statistically significantly better in terms of grip strength and pain scores. At 52 weeks, the mean PFGS score in the MET group was significantly higher and the mean VAS score was significantly lower than those of the CSI group.
The authors concluded that initially the CSI was superior to the MET, but the significant short-term benefits of the CSI were decreased after 6 weeks, whereas the improvements in the physiotherapy group were longer lasting. This evidence should be considered when patients present with Tennis Elbow. Although corticosteroid injections may provide better short term relief from the pain, traditional physiotherapy provides a better long term response and outcome.