When tennis elbow syringes do not help

Tennis elbow: cortisone, hyaluronic acid and botulinum toxin put to the test

04.10.2012

A common treatment for epicondylitis radialis humeri, the so-called „tennis elbow“, is the injection of cortisone, hyaluronic acid, botulinum toxin and other drugs. Researchers at the University of Copenhagen have evaluated 17 randomized controlled trials (RCTs) with just under 1,400 patients to examine the effectiveness of the tips. Her conclusion: The treatment lacks any scientific basis.

Tennis elbow is triggered by overuse
Under a tennis elbow is a painful irritation of the tendon attachments of the muscles of the forearm, which attach to the two bone protrusions above the joint on the humerus. The cause is an overuse of the forearm muscles, which is triggered either by heavy overuse or by constant repetitions of the overload. Often, a one-sided stress such as when using the computer mouse, wrong posture, unfavorable posture during sleep, for example, when the arm is heavily bent used as a headrest, or in racket sports such as golf or tennis cause of the disease. Likewise, another underlying disease, such as fibromyalgia, can trigger the stimulus state of the muscles.

Therapy with syringes on tennis elbow not recommended
According to Dr. Thøger Persson Krogh of the University of Copenhagen and his team heard Epicondylitis radialis humeri, commonly referred to as tennis elbow, to those diseases whose current treatment methods have so far failed to prove their scientific effectiveness. The scientists confirmed with their evaluation one already in the year 2002 in the trade magazine „The Lancet“ published study that came to a similar conclusion. At that time, patient data from GP surgeries were analyzed. In 80 percent of cases, the symptoms subsided after one year by itself.

For the now in the journal „The American Journal of Sports Medicine“ The Danish researchers evaluated 17 randomized controlled trials with just under 1,400 patients and came to a clear conclusion: Injection treatment with the tested drugs is included „tennis elbow“ not recommended.

Cortisone not effective on tennis elbow?
In the meta-analysis, eight different common treatments for „tennis elbow“ scrutinized. The researchers investigated the effect of botulinum toxin, also known under the trade name Botox, sclerotherapy, glucocorticoids, autologous blood, platelet-rich plasma (PRP) and hyaluronic acid, polidocanol and glycosaminoglycan polysulfate. The result of the Danish researchers: After a follow-up period of the patients of an average of 32 weeks, corticosteroid injections were no more effective than placebo for the pain. The situation was similar with polidocanol and cartilage protection with glycosaminoglycan polysulphate. Botulinum toxin performed slightly better than placebo, but led to short-term paralysis in the fingers, so that the Danish researchers rated the drug as not practicable.

Autohemotherapy helps with tennis elbow
A significantly higher efficacy compared to the placebo showed the self-blood therapy. Also, sclerotherapy or proliferation therapy, which involves injecting a sugar-containing solution under the skin, and injecting hyaluronic acid helped better than placebo. However, Krogh and colleagues complained that the studies included in the study were only partially meaningful because some did not meet the Cochrane standards for low risk of bias due to low sample numbers. In addition, only two author teams could prove that they are independent of the company.

The positive result of the meta-analysis was that none of the patients had to stop treatment due to adverse reactions or similar. The most unpleasant therapeutic effects included pain at the injection site and, in rare cases, skin atrophy or pigmentation after injection of cortisone. (Ag)

Image: Stephanie Hofschlaeger