Tennis elbow: How effective is an injection?

  • Tuesday 10 March 2020

Tennis elbow is a painful condition affecting the lateral or outside part of the elbow joint. It is common in elite and non-elite athletes but also affects ordinary people who perform repetitive upper limb activities.

Most cases of tennis elbow settle with education and a rehab programme supervised by a therapist such as a physiotherapist or osteopath. The natural history of tennis elbow is usually complete resolution within 12 to 18 months. However, we know that a sizeable minority of patients do not settle with rehab and seek other treatments.

In the past, cortisone injections have been given to patients with persistent and troublesome pain. However, recent evidence suggests that cortisone may not be good for patients with tennis elbow. As outlined in a paper I co-authored on injections in tendinopathy (https://doi.org/10.1007/s40134-018-0296-2), there is good evidence to suggest that cortisone is not good for this tendon problem. While patients get short term relief of up to 6 weeks with cortisone, they often do WORSE than no treatment. Yes-that's right- patients do worse at 3-6 months than doing nothing at all.

So, if cortisone is not good for tendons, then what can one do to help?

Unfortunately, the evidence is not great for other treatments. There is some low-level evidence that shockwave can improve pain in tennis elbow. Recent studies suggest that placing a medication patch such as GTN can improve symptoms in the medium term. Regarding injections, options include dextrose, PRP (platelet-rich plasma) or dry needling of the tendon under local anaesthetic. There is no evidence that one type of injection is necessarily better than other alternatives. You can read about the evidence in my paper: . https://doi.org/10.1007/s40134-018-0296-2

For me, I suggest education and exercise therapy should be the cornerstone of tennis elbow treatment. Other treatments will depend on individual circumstance and preference, but my preferred adjuncts would be shockwave, GTN patches or dry needling injection. There is no evidence that PRP injections are better than these other treatments, but I have offered PRP to patients who request this treatment or have failed other treatment.

Please view the attached video from an on-line course I've produced with Sonoskills and 123 sonography (123sonography.com) demonstrating a tennis elbow injection.

Dr Masci is offering a one-stop shop for all ultrasound-guided injections at ISEH or Welbeck.

All injections include an initial consultation, an ultrasound scan and an ultrasound-guided injection all in one visit.

He has vast experience in performing injections for osteoarthritis, tendon problems, shoulder, elbow, hand and wrist, hip, knee and ankle and foot pain. He performs steroid injections for conditions such as osteoarthritis, frozen shoulder, heel spurs, shoulder pain, carpal tunnel, trigger finger and thumb osteoarthritis.

He also offers hyaluronic acid and platelet-rich plasma for osteoarthritis of shoulder, hip, knee, ankle and wrist and hand.

He has helped produce and direct an on-line education programme to teach other doctors and professionals on how to perform ultrasound-guided injections at the highest level.

He has written papers on ultrasound-guided injections including this narrative review on injections in tendon disease such as Achilles, tennis elbow and shoulder pain. https://doi.org/10.1007/s40134-018-0296-2


Fees:
Private insurance will usually cover cortisone and hyaluronic acid injections for joints.

For self paying patients: Fee for ultrasound-guided cortisone injections of any joint or tendon is approximately £350 and includes consultation, ultrasound and ultrasound-guided injection.

Fee for ultrasound-guided hyaluronic acid from £395.

Fee for ultrasound-guided platelet-rich plasma from £500 (at Welbeck) or £1400 for three injections.

Book by email info@sportdoctorlondon.com or 0203 488 0350


Tags: ultrasoundinjectionspatientinjuryelbow