Steroid Injections for Tennis Elbow
Tennis elbow is the commonly used term to describe the condition “common extensor muscle origin tendinopathy”. It is caused when the force absorbing capacity of the origin of these muscles is exceeded and breaks down faster than it is repaired.
Symptoms of Tennis Elbow
The most common symptoms of Tennis elbow are:
- Pain on the outside of the elbow which may travel down into the forearm
- Pain on gripping tasks like opening jars
- Pain with lifting objects up with the palm down
- Sensitivity when knocking your elbow against objects like door frames
- Pain with gripping and pulling activities like opening door handles
Anatomy of the Elbow joint
The elbow joint is a hinge joint made up of the upper arm bone (Humerus) and 2 forearm bones (Radius and Ulnar). Important muscles cross the elbow joint, their function is to bend the arm up as well move the wrist and fingers. The elbow joint is stabilised by ligaments running either side of the joint called the Radial and Ulnar Collateral Ligaments. A third ligament, the Annular Ligament holds the Radius and Ulnar together. The elbows main functions are to allow bending and straightening of the arm as well as supination and pronation, which is turning the palm to face up and down respectively.
How is Tennis Elbow diagnosed?
Assessment with a Physiotherapist is essential to work out if you have tennis elbow. Our Physiotherapists will ask a series of questions and perform a physical examination to work out if it is tennis elbow or another painful condition of the elbow. At Oxford Circus Physiotherapy we also use diagnostic ultrasound to image the tendon attachment and joint to check for tears of the tendon or swelling in the joint.
The most common cause of Tennis Elbow is overuse of the muscles that extend the wrist. This may occur from performing an activity you do not normally do and doing an excessive amount of it in a short space of time. Alternatively it may be caused by doing an activity that loads these muscles for a prolonged period of time eg; putting together flat pack furniture or practising backhand stroke at tennis repeatedly. If the attachment becomes inflamed, and or there is not adequate rest time before repeating the activity again, the tendon gradually breaks down and becomes painful.
Simple measures like paracetamol and icing may help initially. If pain persists you may also need to be on a structured strengthening routine. The majority of Tennis Elbow symptoms will usually resolve with these measures (Barr et al 2009). However if pain persists then treatment options to aid healing also include:
- Shockwave Treatment – This involves sending a strong sound wave into the tissue to stimulate an inflammatory response which may speed up the healing of the tendon and reduce pain.
- Ultrasound-guided Dry Needling
Ultrasound-guided injection therapy for the treatment of tennis elbow can be controversial. There is often evidence for and against various interventions. Studies comparing PRP (Platelet Rich Plasma) with cortisone in Tennis Elbow have been conducted and found that PRP has a better long term effect than injecting steroid (Tang et al 2020). However PRP was found to be no better than placebo by a Cochrane review (Karjalainen et al 2021).
Certain treatments may also involve dry needling when injecting PRP or Hyaluronic acid. Injection treatments that we perform at Oxford Circus Physiotherapy are:
- PRP Injection
- Hyaluronic Acid Injection
- In cases where other treatments are contraindicated and pain is a significant limiting factor, then an ultrasound-guided steroid injection with local anaesthetic can be considered. Research shows this gives the poorest long term outcome (Tang et al 2020, Inklebarger & Clarke 2015, Hsieh et al 2018) so is only good to relieve pain in the short term.
Tang S, Wang X, Wu P, Wu P, Yang J, Du Z, Liu S, Wei F. Platelet-Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta-Analysis of Randomized Controlled Trials. PM R. 2020 Apr;12(4):397-409. doi: 10.1002/pmrj.12287. Epub 2020 Jan 13. PMID: 31736257; PMCID: PMC7187193.
Karjalainen TV, Silagy M, O’Bryan E, Johnston RV, Cyril S, Buchbinder R. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD010951. DOI: 10.1002/14651858.CD010951.pub2.
Barr, S. Cerisola, F. Blanchard, V. Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review, Physiotherapy, Volume 95, Issue 4, 2009, Pages 251-265, ISSN 0031-9406, https://doi.org/10.1016/j.physio.2009.05.002. (https://www.sciencedirect.com/science/article/pii/S0031940609000595)
Inklebarger, J. Clarke, T. (2015) Corticosteroid injections for tennis elbow – A hard habit to break, International Musculoskeletal Medicine, 37:3, 108-110, DOI: 10.1179/1753614615Z.000000000108
Hsieh, Lin-Fen MD; Kuo, Ying-Chen MD; Lee, Chia-Cheng MD; Liu, Ya-Fang PhD; Liu, Yu-Chia MD; Huang, Vincent MD Comparison Between Corticosteroid and Lidocaine Injection in the Treatment of Tennis Elbow, American Journal of Physical Medicine & Rehabilitation: February 2018 – Volume 97 – Issue 2 – p 83-89