Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): a survey of current UK specialist practice and a call for clinical guidelines

Abstract

BackgroundTennis elbow is a common condition with a variety of treatment options, but little is known about which of these options specialists choose most commonly. Corticosteroid injections in tennis elbow may reduce pain in the short-term but delay long-term recovery. We have undertaken a UK-wide survey of upper limb specialists to assess current practice.MethodsCross-sectional electronic survey of current members of the British Elbow and Shoulder Society (BESS) and the British Society for Surgery of the Hand (BSSH).Results271 of 1047 eligible members responded (25.9%); consultant surgeons constituted the largest group (232/271, 85%). 131 respondents (48%) use corticosteroid injections as their first-line treatment for tennis elbow. 206 respondents (77%) believed that corticosteroid injections are not potentially harmful in the treatment of tennis elbow, while 31 (11%) did not use them in their current practice. In light of recent evidence of the potential harmful effects of corticosteroid therapy, 136 (50%) had not changed their practice while 108 (40.1%) had reduced or discontinued their use. 43 respondents (16%) reported having used platelet-rich plasma injections.ConclusionsRecent high-quality evidence that corticosteroids may delay recovery in tennis elbow appears to have had a limited effect on current practice. Treatment is not uniform among specialists and a proportion of them use platelet-rich plasma injections.

Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis

“…Although CS injection is the most commonly used injection therapy,43 our data suggest it is a suboptimal choice whether or not it is combined with PEP. This finding might have partly occurred because the extracted data in our review were the results of the follow-up closest to 6 months (26 weeks), which is usually considered an intermediate term.…”

Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial

“…Conclusions are in agreement with a large body of clinical evidence5–7 that states corticosteroid injection should not be recommended as a first-line intervention for LE. Given that 48% of surveyed UK specialists continue to use corticosteroid injection as a first-line intervention for LE, and half stated they had not changed their practice in light of recent evidence, it appears penetrance of the latest evidence remains poor 4 25…”

“…Corticosteroid injection remains in widespread use,4 despite systematic review evidence showing worse outcomes in the long term compared to a ‘wait and see’ approach or physiotherapy 5. Inconsistent long-term clinical benefits of physiotherapy are observed,6 7 raising debate as to whether the surplus value of physiotherapy is worth the additional resources needed for treatment.…”

Patterns of platelet-rich plasma use among Australasian sports physicians

“…Previous surveys have assessed the use of cortisone injections among orthopaedic surgeons and found surprising evidence-practice gaps 18. The Australasian College of Sports Physicians is a common training programme for specialists working in Australia or New Zealand.…”