What role do corticosteroid injections play in the management of lateral epicondylitis, and what are the potential risks?

Corticosteroid injections for lateral epicondylitis (tennis elbow) are primarily associated with short-term symptom relief ¹. They can provide improved pain, function, and global improvement outcomes at around 6 weeks compared with placebo, orthoses, physiotherapy, and oral NSAIDs ¹. Short-term benefits, typically less than 12 weeks, have been observed for pain relief and functional improvement ¹.

However, corticosteroid injections are not routinely offered for tennis elbow due to concerns about long-term outcomes and recurrence rates ¹. At 1 year follow-up, individuals treated with corticosteroid injections may experience the same or more symptoms than those who did not receive an injection, and some may have worse long-term outcomes compared to those receiving physiotherapy or oral NSAID treatment ¹. There is moderate-quality evidence suggesting that corticosteroid injections may increase the recurrence rate of tennis elbow compared with physiotherapy and a watch-and-wait approach at 6 weeks follow-up ¹. Reported recurrence rates after corticosteroid injection have been as high as 37% at 6 months and 72% at 6 weeks ¹. The BMJ Best Practice guide advises against the use of corticosteroid injections for this condition ¹.

The main potential risks and negative implications associated with their use in lateral epicondylitis include higher recurrence rates and less favourable long-term outcomes compared to other treatments or no treatment ¹. Clinicians are advised to explain the possible adverse effects and long-term implications of corticosteroid injections, which is considered good medical practice ¹.