Getting a cortisone injection won't help tennis elbow any more than a drug-free saline shot - and it may actually slow recovery, according to an Australian study.
Researchers writing in the Journal of the American Medical Association found that a few weeks after receiving the steroid shots, people reported less pain and disability than those who'd been given placebo injections. But a year later, those same patients lagged behind the placebo group in their likelihood of complete recovery.
"The use of corticosteroid injection versus placebo injection resulted in worse clinical outcomes after one year, and physiotherapy did not result in any significant differences," wrote lead researcher Bill Vicenzino from the University of Queensland in Australia and his colleagues.
Tennis elbow is caused by the overuse of tendons in the elbow and typically treated with non-steroidal anti-inflammatory drugs, physical therapy and steroid shots.
Vicenzino and his team randomly assigned 165 adults with tennis elbow to one of four treatment groups: cortisone shots with physical therapy, placebo shots with physical therapy, cortisone shots without physical therapy and placebo shots without physical therapy.
After one year, there was no difference in people's improvement in pain or functioning based on whether they'd had the eight sessions of prescribed therapy.
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.
Symptoms were also more likely to come back after a cortisone injection. The research team calculated that one more person would have a recurrence for every two or three treated with steroids instead of a saline shot.
"This absolutely confirms that steroid injections are not a good idea," said Allan Mishra, an orthopedic surgeon at Stanford University, who was not part of the study.
"This is important because people think that it's okay to get a cortisone injection (for tennis elbow) and it's not okay. It puts you at a disadvantage long term in terms of getting better."
Mishra said researchers are looking for better treatments to address what is causing tendon pain in the first place, such as weakening of collagen in the tendon. One possible option being studied by himself and others is so-called platelet-rich injections.
Many cases of tennis elbow also go away on their own with time and basic stretching, Mishra added.
"I think home-based exercises are probably sufficient for treating this," he said.
"You'd be better off with that than with a cortisone injection. That's what you should start with, because you might not even need physical therapy."