Tennis Elbow: Mobilisation With Movement And Exercise, Corticosteroid Injection, Or Wait And See. Which Is Faster?
Tennis elbows occur fairly often around 1-3% of the general population. Meaning some 165,000 people in Singapore are suffering from this condition at some point in time. Given it is common condition, it is important to find out what the fastest treatment approach to getting better is. A team of researchers in Brisbane, Australia decided to find out. They decided to conduct a randomised trial to compare between a physiotherapy treatment technique -mobilisation with movement and exercise- against corticosteriod injections and wait-and-see.
198 patients with untreated tennis elbow for 6 weeks were recruited.
Physiotherapy vs Wait-And-See
In the long-run after 52 weeks, there was no difference in outcomes between the physiotherapy group and the wait-and-see group. Tennis elbow is one of those conditions that improve, especially when given sufficient time and rest.
In the short-term, however, the physiotherapy group showed significant improvement (including reduction in pain), particularly in the first 6 weeks.
Physiotherapy vs Corticosteriod Injection
Unsurprisingly, the Corticosetriod Injection group for tennis elbow showed significantly better results in the first 6 weeks compared to the physiotherapy and the wait-and-see group. However, there were high recurrence rate of regression after 6 weeks; meaning it got worse again (over 72% of the group).
In the long-term, the outcomes in overall improvements and measures like grip strength were poorer than if the group had physiotherapy or wait-and-see.
Phsiotherapy For The Mid-To-Long Term And Corticosteroid Cautiously For The Short Term
Researchers from the University of Queensland, Australia concluded that, physiotherapy combining elbow manipulation and exercise was a better approach. This is in comparison to wait and see in the first six weeks, and to corticosteroid injections after six weeks. This suggested a reasonable alternative to injections in the mid to long term. The short-term benefits of corticosteroid injection were paradoxically reversed after six weeks. This came with high recurrence rates. As such, this treatment should hence be used with caution.
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- Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial, Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino BMJ Nov 4, 2006,
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