Steroid Shots NOT helpful for Tennis Elbow

For years now, physicians of all types have recommended steroid injections for tennis elbow.  There has been some debate about the value of these injections.  It is time to declare there is no significant value and they may actually be harmful.  A new study published today by the Journal of the American Medical Association (JAMA) evaluated 165 patients in a prospective, randomized fashion.  In this study, patients were given a corticosteroid injection or a placebo injection.  Physical therapy was also added.  Reuters Health ran a story about the study today.  Here are some excerpts:  

(Reuters Health) - "Getting a cortisone injection won't cure tennis elbow any better than a drug-free saline shot, according to a new study - and it might actually slow recovery."

"Among those who'd received a cortisone shot, 83 percent reported they had completely recovered from tennis elbow by one year. That compared to 96 percent of those who'd received a placebo injection, according to findings published Tuesday in the Journal of the American Medical Association."

"This evidence does not support the clinical practice of using corticosteroid injection to facilitate active rehabilitation," the study team wrote."

Read the full article by Genevra Pittman from Reuters.  

It is clear form published peer reviewed data that cortisone injections have little or no value in the treatment of tennis elbow.  Data suggests a platelet rich plasma injection is significantly better option than cortisone.   Or, try a simple stretching and strengthening program.  Always also consult with a physician also to make sure you have a proper diagnosis.

Simple Tennis Elbow Stretches

Simple Tennis Elbow Strengthening Exercises

AM
TotalTendon

Platelet Rich Plasma JAMA Article

A recently published article by de Vos et al in JAMA has resulted in a flurry of lay press articles declaring platelet rich plasma (PRP) does not work.  Much like the overhype of PRP after Hines Ward was treated just before the Super Bowl last year, this declaration cannot be defended.

In their study, patients with MODERATE achilles tendinopathy did not do better with PRP compared to saline controls.  All patients received eccentric strengthening exercises.  Their data does support the conclusion that PRP is not better than saline but ONLY for moderate tendinopathy (as measured clinically, no imaging data was reported) at six months of follow up.    The authors stated they will be following those patients for a year.  If for some reason, the PRP patients continue to improve and the saline ones do not, there could be a difference at one year.  However, the conclusion could then only be made that PRP works for MODERATE achilles tendinopathy not any other clinical entity.  Patients with SEVERE tendinopathy that has failed eccentric training was not tested in this study.

The authors need to be recognized for completing this study as we need more level one evidence like it to best define how to use PRP.  Soon, we will have more published literature to discuss. 

We still need to define the optimal formulation and dosage of PRP.  No data was collected on the patients with regard to what was actually put into the patient in terms of total platelet concentration and or white blood cell concentration.  Importantly, we also need a better understanding of the mechanisms behind PRP.