Injecting steroids for tennis elbow has been the standard primary care treatment for decades. Only recently has the evidence for their long-term effectiveness been found wanting (see
Synovium 32). However, we are aware that established practice changes slowly in the light of emerging evidence – remember antibiotics for otitis media. In the last few years many other injection treatments have emerged to treat this common and persistent tendinopathy. It is tempting to think that newer and more effective treatments might quietly replace steroid injections in everyday practice. A systematic review and meta-analysis of randomised controlled trials (RCTs) examining the effectiveness and safety of novel treatments for tennis elbow as compared with steroid injections was recently published in the American Journal of Sports Medicine. The trials were also assessed using the ‘Cochrane risk of bias tool’. 1 2
Data from 10 RCTs confirmed the lack of effectiveness of steroid injections after 8 weeks. Data from 4 trials of botulinum toxin showed marginal effectiveness but this was accompanied by temporary weakness of finger extension. Autologous blood (3 RCTs) and platelet-rich plasma (2 RCTs) were, statistically, more effective than placebo. Other injections with 1 RCT each were prolotherapy, hyaluronan, glycoaminoglycan and polidocanol. In all, 17 RCTs were included in the study. Disappointingly only 4 were found to have a low risk of bias using the Cochrane tool. Of these only one (prolotherapy) showed evidence of effectiveness compared with placebo. So – plenty more work to be done before novel injections become standard treatments.