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Corticosteroids for Tennis Elbow
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How It Works
A local anesthetic (lidocaine) may be used first to help with diagnosis. If this shot improves the pain, then a corticosteroid injection is given. Lidocaine is sometimes given with a corticosteroid to reduce the pain of the injection.
Why It Is Used
A corticosteroid injection is sometimes used to treat tennis elbow. Corticosteroids are given to relieve the pain of tennis elbow when other forms of treatment haven't helped.
If you don't find long-term relief after a total of three injections over the course of a year, more injections aren't likely to help and may cause harm.
Some doctors believe that corticosteroids should not be given to children.
Corticosteroid treatment is not used when infection is suspected.
How Well It Works
Studies suggest that corticosteroid injections may give short-term relief but don't have long-lasting benefit when compared to other treatments.1 And a large analysis of many corticosteroid studies suggests that in the long term corticosteroids are worse than other treatments.2 For example, one study found that although corticosteroid injection produced the most relief after 6 weeks, it was linked to more relapse and pain after 6 weeks and after 52 weeks than treatment with watchful waiting or rehabilitation.3
Corticosteroids are used with caution because of potential side effects. Side effects may include:
- Increased pain the first day or two after a corticosteroid injection. Apply ice at home for 15 to 20 minutes after the injection to help reduce pain.
- Tendon weakening and scarring, causing loss of strength and movement and potential for tendon rupture.
- Accidental nerve injury during injection.
- Skin color (pigmentation) changes.
- Dimpling of the skin (subcutaneous atrophy).
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Try using nonsurgical treatment (such as rest, rehabilitation exercises, ice, and the use of nonsteroidal anti-inflammatory drugs) to relieve pain and inflammation before considering corticosteroids.
There may be fewer side effects and less pain when corticosteroids are given through iontophoresis. Iontophoresis is a drug delivery method that uses an electrical current to move the drug through the skin into the tissue. Because this method is less painful than hypodermic needle delivery, some people may start rehabilitation sooner and experience faster pain relief.4
- Buchbinder R, et al. (2008). Tennis elbow, search date August 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Coombes BK, et al. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. Lancet, 376(9754): 1751–1767.
- Bisset L, et al. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. BMJ, 333(7575): 939.
- Nirschl RP, et al. (2003). Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. American Journal of Sports Medicine, 31(2): 189–195.
Last Revised: January 21, 2011
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