Corticosteroid injections provide optimal short-term pain relief in patients with tennis elbow, a primary care study has found. However, 84 per cent of the 164 patients recruited to the trial had recovered after 12 months, regardless of the treatment they received (BMJ 1999;319:964).
Dr Elaine May (senior lecturer in community rheumatology, school of postgraduate medicine, Keele university) and colleagues compared a local injection of methylprednisolone 20mg, a two week course of enteric coated naproxen 500mg twice daily and a two week course of placebo twice daily for the treatment of tennis elbow. All patients received co-codamol when required. Four weeks after treatment, patients in the corticosteroid group were significantly better than either the naproxen or placebo groups. There was no difference in outcome between the naproxen and placebo groups. At six months, some subjects in the injection group had relapsed and there were small but significant benefits of naproxen and placebo compared with methylprednisolone. However, after 12 months, the three groups had similar results.
The authors conclude that a local corticosteroid injection is a safe and effective initial treatment if the objective is to provide optimal pain relief in the early stages of tennis elbow, and that naproxen has no advantage over simple analgesics.