About 1 to 3 percent of Americans develop tennis elbow — an overuse injury that causes chronic pain around the outside of the elbow — but the treatments given many sufferers appear to be ineffective in the long-run. Most would eventually get better on their own, researchers reported Tuesday.
A clinical trial published in the Journal of the American Medical Association found that patients who received standard treatments such as a cortisone injection and physical therapy fared no better after one year than those who went untreated. The researchers found no differences in whether patients experienced long-term pain relief or a recurrence of the condition.
Australian researchers recruited 165 players with the condition — which can occur with any repetitive arm, elbow, wrist or hand movement, especially while tightly gripping something such as a golf club, vacuum cleaner, or tennis racket — and randomly assigned them to one of four groups. The groups got either a cortisone shot alone, a shot with eight weeks of physical therapy, a placebo shot with eight weeks of therapy, or a placebo shot alone.
One year later, the researchers found that none of the treatments worked better than a placebo for long-term relief and that those who had the cortisone injection (either alone or with physical therapy) were significantly less likely to have made a full recovery than those who had a placebo or physical therapy without the cortisone shot. They reported that 83 percent of patients who had the cortisone shot had a complete resolution of their tennis elbow compared with 96 percent of those who had the placebo injection.
The cortisone shot, however, was much better than the placebo for relieving pain and immobility and improving a patient’s quality of life within the first four weeks of treatment.
Interestingly, physical therapy provided somewhat smaller benefits than the cortisone shot for short-term pain relief, but most patients who had the therapy didn’t need to rely as much on over-the-counter, anti-inflammatory pain relievers — which can have gastrointestinal side effects. While physical therapy didn’t work better than no treatment over the long haul, it also didn’t hinder recovery, which occurred with the cortisone shot.
“Contrary to our hypothesis and to a generally held clinical view,’’ wrote the study authors, “we found that multimodal physiotherapy provided no beneficial long-term effect on complete recovery or much improvement, recurrence, pain, disability, or quality of life. However, physiotherapy should not be dismissed altogether because in the absence of the corticosteroid, it provided short-term benefit across all outcomes.’’