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Tennis elbow and injections of corticosteroids
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amarius


Feb 6, 2013, 1:12 PM
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Registered: Feb 23, 2012
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Tennis elbow and injections of corticosteroids
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Study showed again that corticosteroids are not the best treatment options

In short -
In reply to:
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.

Sort of amusing that nothing is better than steroid treatment


onceahardman


Feb 6, 2013, 4:12 PM
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Re: [amarius] Tennis elbow and injections of corticosteroids [In reply to]
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amarius wrote:
Study showed again that corticosteroids are not the best treatment options

In short -
In reply to:
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.

Sort of amusing that nothing is better than steroid treatment

Caution is advised here...and I'm not saying I like steroids as a first course for tendinitis- I don't.

You linked to a Yahoo article, which does not link to the actual study. The study, however, is decribed as "small". How small? is 83% statistically significantly less than 93% in this study? Don't know.

Studies which include a "black box" treatment simply called "physical therapy" without describing what kind of PT was used are inherently faulty. Therapeutic exercise? deep friction massage? Manual therapy including mobilization or manipulation? Electric stimulation? Ultrasound? Hot packs? Cold packs? Ice massage? Shortwave diathermy? Dry needling? All of these are "physical therapy", and I've probably neglected to mention some.

The meat of all studies is found in the section called, "Methods." Since we don't have access to the actual paper, I suggest it is premature to reach any conclusions.


altelis


Feb 6, 2013, 6:53 PM
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Re: [onceahardman] Tennis elbow and injections of corticosteroids [In reply to]
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And to piggy back on that, two big questions I have are:
-We don't know if this was a prospective or retrospective study
-(and related) We don't know how the patients were assigned to their group.

If this was a randomized prospective study the results are a lot more meaningful than a non-randomized retrospective study...


iknowfear


Feb 7, 2013, 12:03 AM
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Re: [amarius] Tennis elbow and injections of corticosteroids [In reply to]
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amarius wrote:
Study showed again that corticosteroids are not the best treatment options

In short -
In reply to:
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.

Sort of amusing that nothing is better than steroid treatment

just to put it back out there
https://sites.google.com/site/healgolferselbow/

note: I did not use this treatment, nor can comment on its effectiveness.


amarius


Feb 7, 2013, 5:52 AM
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Registered: Feb 23, 2012
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Re: [onceahardman] Tennis elbow and injections of corticosteroids [In reply to]
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Even though I could post the whole article online it could be construed as a copyright violation. Of course summary is freely available.

Since it might go away at some point, here it is:
In reply to:
Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral EpicondylalgiaA Randomized Controlled Trial
Brooke K. Coombes, PhD; Leanne Bisset, PhD; Peter Brooks, MD, FRACP; Asad Khan, PhD; Bill Vicenzino, PhD
JAMA. 2013;309(5):461-469. doi:10.1001/jama.2013.129.


Importance Corticosteroid injection and physiotherapy, common treatments for lateral epicondylalgia, are frequently combined in clinical practice. However, evidence on their combined efficacy is lacking.

Objective To investigate the effectiveness of corticosteroid injection, multimodal physiotherapy, or both in patients with unilateral lateral epicondylalgia.

Design, Setting, and Patients A 2 2 factorial, randomized, injection-blinded, placebo-controlled trial was conducted at a single university research center and 16 primary care settings in Brisbane, Australia. A total of 165 patients aged 18 years or older with unilateral lateral epicondylalgia of longer than 6 weeks' duration were enrolled between July 2008 and May 2010; 1-year follow-up was completed in May 2011.

Interventions Corticosteroid injection (n = 43), placebo injection (n = 41), corticosteroid injection plus physiotherapy (n = 40), or placebo injection plus physiotherapy (n = 41).

Main Outcome Measures The 2 primary outcomes were 1-year global rating of change scores for complete recovery or much improvement and 1-year recurrence (defined as complete recovery or much improvement at 4 or 8 weeks, but not later) analyzed on an intention-to-treat basis (P < .01). Secondary outcomes included complete recovery or much improvement at 4 and 26 weeks.

Results Corticosteroid injection resulted in lower complete recovery or much improvement at 1 year vs placebo injection (83% vs 96%, respectively; relative risk [RR], 0.86 [99% CI, 0.75-0.99]; P = .01) and greater 1-year recurrence (54% vs 12%; RR, 0.23 [99% CI, 0.10-0.51]; P < .001). The physiotherapy and no physiotherapy groups did not differ on 1-year ratings of complete recovery or much improvement (91% vs 88%, respectively; RR, 1.04 [99% CI, 0.90-1.19]; P = .56) or recurrence (29% vs 38%; RR, 1.31 [99% CI, 0.73-2.35]; P = .25). Similar patterns were found at 26 weeks, with lower complete recovery or much improvement after corticosteroid injection vs placebo injection (55% vs 85%, respectively; RR, 0.79 [99% CI, 0.62-0.99]; P < .001) and no difference between the physiotherapy and no physiotherapy groups (71% vs 69%, respectively; RR, 1.22 [99% CI, 0.97-1.53]; P = .84). At 4 weeks, there was a significant interaction between corticosteroid injection and physiotherapy (P = .01), whereby patients receiving the placebo injection plus physiotherapy had greater complete recovery or much improvement vs no physiotherapy (39% vs 10%, respectively; RR, 4.00 [99% CI, 1.07-15.00]; P = .004). However, there was no difference between patients receiving the corticosteroid injection plus physiotherapy vs corticosteroid alone (68% vs 71%, respectively; RR, 0.95 [99% CI, 0.65-1.38]; P = .57).

Conclusion and Relevance Among patients with chronic unilateral lateral epicondylalgia, the use of corticosteroid injection vs placebo injection resulted in worse clinical outcomes after 1 year, and physiotherapy did not result in any significant differences.

I have to say, the summary is way better than the article written for the broad public.


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