Commonly used steroid shots may worsen tennis elbow in the long run and increase chances that the painful condition will reappear, a small study found.
By contrast, patients who got dummy injections alone or with physical therapy were more likely to completely recover after a year and much less likely to have a recurrence than those given steroids.
While the Australian study results echo previous findings, injections of cortisone or similar steroids are still widely recommended by doctors to treat tennis elbow and similar conditions, probably because they can provide short-term pain relief.
The results from this study and others show that steroid shots shouldn't be the main treatment for tennis elbow, said researcher and co-author Bill Vicenzino the University of Queensland.
His study appears in Wednesday's Journal of the American Medical Association.
So-called tennis elbow is caused by repetitive activity or overuse of the arm, which can cause small tears in tendons that attach to the elbow bone. Rest, applying ice, and over-the-counter pain medicine can help relieve symptoms.
The study involved corticosteroids, often used medically to reduce inflammation. These are different from hormone-related anabolic steroids used to treat certain diseases but which are banned in many professional sports because they can build muscle and improve performance.
The researchers enrolled 165 adults aged 18 and older; each had tennis elbow in one arm for longer than six weeks. They were divided into four treatment groups: a single steroid injection; a shot of a dummy liquid; a steroid shot plus about eight weekly half-hour sessions of physical therapy; or a dummy injection plus physical therapy.
After four weeks, steroid patients fared best, but after one year, those who didn't get a steroid shot did better. All the patients who had physical therapy without steroids and 93 percent who got just dummy injections reported complete recovery or much improvement, versus about 83 percent of those who had steroids with or without physical therapy.
A recurrence of tennis elbow was reported by about half of the patients in both steroid groups, compared with just 5 percent of the physical therapy patients and 20 percent in the placebo group.
Despite the differences, more than 80 percent of patients in each group were much better or recovered after one year, showing that tennis elbow generally improves over time regardless of treatment.
One reason steroid injections aren't always the best choice is that they reduce the pain without fixing the underlying problem, so patients are more likely to resume activity too soon, said Dr. Michael Perry, a sports medicine specialist at Northwestern Memorial Hospital in Chicago.