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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 is suffering from this condition at some point in time. Given it is common condition, it is then an interesting question to find what is the fastest treatment approach to getting better. This was the question that a team of researchers in Brisbane, Australia decided to find out definitely. They decided to conduct a randomised trial to compare between a physiotherapy treatment technique – mobilisation with movement and exercise against corticosteriod injections and finally against just waiting and see.

Some 198 patients with tennis elbow that were untreated for the past 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 do get better 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 showed significantly better effect 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).

Over the long-term, the outcomes in terms of 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

From their finding, researchers from the University of Queensland, Australia concluded that physiotherapy combining elbow manipulation and exercise was a better approach than 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 significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow

Reference:

  1. 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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