Although the study found physical therapy combined with injection was not particularly helpful, the authors said physical therapy alone should not be ruled out completely as it provided short-term relief, the lowest recurrence rates and much improvement or recovery after a year.
The real message of this study is that the best way to treat tennis elbow isn't known, Kowalsky said. "We really don't know how to treat these patients if they don't respond to physical therapy."
For the study, published in the Feb. 6 issue of the Journal of the American Medical Association, Vicenzino's team randomly assigned 165 patients with tennis elbow to one of four treatments: a steroid injection; a placebo injection; a steroid injection and physical therapy, or a placebo injection and physical therapy. Patients had about eight weekly therapy sessions, on average.
After a year, the investigators found that 83 percent of those who had a steroid injection had a complete recovery or were much improved, compared with 96 percent of those who had the placebo injection.
Moreover, 54 percent of those who got the steroid injection had a recurrence of tennis elbow, compared with only 12 percent of those given the placebo, the researchers said.
No significant differences in recovery or recurrence were noted between those who had physical therapy and those who didn't.
Nor was there a significant difference between patients who got the steroid shot alone compared to patients who got the injection plus physical therapy.
"Our findings did not support the commonly held view that any recurrence or delayed healing effect following corticosteroid injection can be remedied by moderating loads and a program of physiotherapy," Vicenzino said.
Another expert agrees steroid injections don't help tennis elbow. Instead, Dr. Andrew Rokito, chief of shoulder and elbow surgery at NYU La
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