Q: I've heard you shouldn't have steroid injections for tennis elbow anymore. But that's what my PA has suggested. Should I do it?
A: Steroid injections are no longer routinely recommended for lateral epicondylitis (tennis elbow). But there are times when a physician or physician's assistant (PA) may make this recommendation.
Steroid injections have fallen out of favor for the treatment of lateral epicondylitis but are still used by some physicians in certain carefully selected patients. The disadvantages of steroid injection include only short-term pain relief and disruption of the body's natural healing process.
Steroid injections do not change the underlying pathology. And in the case of degenerative rather than inflammatory epicondylitis, steroids can actually delay healing. Since steroid injections offer only temporary benefit with potential drawbacks, the question has been raised: why use them at all?
Pain relief (even if temporary) is valuable. Turning off pain signals at the tendon-bone interface can help break the pain cycle. This gives the patient an opportunity to rehab under the guidance of the therapist.
And it may not be the medication itself that is the problem but rather the method of delivery (injection). Future studies are needed to compare patients who receive no treatment with those who are given a placebo treatment. It's important to sort out the real reason(s) why some patients improve while others don't (or improve at a slower rate).
Is it truly the method of drug delivery or just a matter of time, or the hand therapy? There are questions the authors intend to pursue further in future research efforts to find the fastest, most effective treatment for lateral epicondylitis.
Physical Therapists offer an alternative treatment in the form of something called iontophoresis. Iontophoresis uses a small electric current to drive steroid medication through the skin. It is a noninvasive method of reducing the pain of tennis elbow. If you don't want a steroid injection, you may ask your physician's assistant (PA) about the possibility of trying iontophoresis instead. If you don't get the desired results with iontophoresis, you can always go back for the injection later.
Reference: Amalia Stefanou, MD, et al. A Randomized Study Comparing Corticosteroid Injection to Corticosteroid Iontophoresis for Lateral Epicondylitis. In The Journal of Hand Surgery. January 2012. Vol. 37A. No. 1. Pp. 104-109.
Should I have steriod injections for tennis elbow?
