What is the efficacy of physiotherapy, corticosteroid injection, and watchful waiting in the treatment of lateral epicondylitis (tennis elbow)?

Updated: Oct 30, 2018
  • Author: Bryant James Walrod, MD; Chief Editor: Craig C Young, MD  more...
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In 2006, Bisset et al investigated treating lateral epicondylitis with physiotherapy, corticosteroid injection, or watchful waiting in 198 individuals with symptoms for greater than 6 weeks. [1] Outcomes were global improvement in symptoms, pain-free grip force, and assessment of severity of complaints. There were significant reductions in all outcomes measured for corticosteroid injections over watchful waiting at 6 weeks. In the corticosteroid group, 78% reported success, versus 27% for those in the watchful waiting group. Corticosteroid injections also outperformed physiotherapy at 6 weeks, with 65% of the physiotherapy group having success versus 78% of the corticosteroid group. Physiotherapy was superior to watchful waiting at 6 weeks. However, the improvement in symptoms with corticosteroid injections was not sustained at 52 weeks.

At 52 weeks, the injection group was significantly worse on all outcomes compared with the physiotherapy group and worse on 2 of 3 measures compared with watchful waiting. Finally, at 52 weeks, there was not much of a difference in comparing physiotherapy to watchful waiting. Fifty-nine of 63 much improved or completely recovered in the physiotherapy group, versus 56 of 62 in the watchful waiting group. This study again elucidates that corticosteroid injections may have some benefit in the short term, but the long-term benefits are definitely lacking in the treatment of lateral epicondylitis. Physiotherapy demonstrated improvement versus watchful waiting at 5 weeks, with only slight improvement at 52 weeks. [1]

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