They want to stick a steroid injection into my Tennis elbow! Noooooo!

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Today it is still common place for Tennis elbow to get stuck with a steroid injection. Just the other day I saw somebody who'd had several done and each time the effect was shorter and shorter.


My head was in my hands.


Why?


Firstly, Tennis elbow is a Tendinopathy which essentially means it is a pathology of the tendon. The reason that they call it this, is because Tendinitis basically means inflammation of tendon and the current thoughts are that it is not an inflammatory problem:

Stanton (2012) describes Lateral epicondylitis (Tennis elbow) as tendinosis of the origin of Extensor Carpi Radialis Brevis (ECRB) tendon & is not an inflammatory process.


The fact is that Corticosteroids are mainly used to reduce inflammation and suppress the immune system according to the NHS website. So at best for this type of condition they would be barking up the wrong tree and ineffective. Not to mention that inflammation is needed to heal the tendon so taking it away doesn't sound very clever.


However this isn't where the story ends!
Are they actually bad for Tennis elbow?


Physio & placebo injection gave better results than steroid injections with elbow injuries in the short & long term and Corticosteroid injection versus placebo injection resulted in worse clinical outcomes after 1 year with Tennis elbow (Coombes et al 2013).

So Tennis elbow was in fact made worse in the long term by injecting steroid!


In fact Olaussen et al (2013) found that although there was a short term benefit there was a negative effect in the intermediate term.


What are the negative side effects of the steroid?


Well there are many, but the British National Formulary states that it weakens muscle, bone and tendon and leads to ruptured (snapped) tendons.

If you are interested here is the full list of side effects:

http://www.evidence.nhs.uk/formulary/bnf/current/6-endocrine-system/63-corticosteroids/632-glucocorticoid-therapy/side-effects-of-corticosteroids

I always treat my patients on the basis of how I would treat myself. So having said that, would I have even one Corticosteroid injection into my 'theoretical' Tennis elbow?

Short answer.....No way!


Even if it gave short term relief and had no negative effects you still aren't getting to the route cause of the problem and this is the true key to long term successful outcomes.


So if you want to get assessed and looked at, then you can contact me on any of the following:

Telephone: 01782 771861
Mobile: 07866195914
Email: mathewhawkesphysiotherapy@gmail.com


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