Corticosteroids for tennis elbow

Examples

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Injections (shots)

Brand Name	Chemical Name
Hexadrol Phosphate	dexamethasone sodium phosphate

Brand Name	Chemical Name
Depo-Medrol	methylprednisolone acetate

How It Works

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Corticosteroids relieve pain and inflammation.

A local anesthetic (lidocaine) may be used first to help with diagnosis. If this shot improves the pain, then a corticosteroid injection is given. Lidocaine is sometimes given with a corticosteroid to reduce the pain of the injection.

Why It Is Used

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Corticosteroid injection is sometimes used to treat tennis elbow. Corticosteroids are given to relieve the pain of tennis elbow when other forms of treatment haven't helped.

If you don't find long-term relief after a total of three injections over the course of a year, more injections aren't likely to help and may cause harm.

Some doctors believe that corticosteroids should not be given to children.

Corticosteroid treatment is not used when infection is suspected.

How Well It Works

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Studies suggest that corticosteroid injections may give short-term relief but don't have long-lasting benefit when compared to other treatments.¹ One study found that, although corticosteroid injection produced the most relief after 6 weeks, it was linked to more relapse and pain after 52 weeks than treatment with rest and rehabilitation.²

Side Effects

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Corticosteroids are used with caution because of potential side effects. Side effects may include:

• Increased pain the first day or two after a corticosteroid injection. Applying ice at home for 15 to 20 minutes after the injection may help reduce pain.
• Tendon weakening and scarring, causing loss of strength and movement and potential for tendon rupture.
• Accidental nerve injury during injection.
• Skin color (pigmentation) changes.
• Dimpling of the skin (subcutaneous atrophy).
• Infection.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Try using nonsurgical treatment (such as rest, rehabilitation exercises, ice, and the use of nonsteroidal anti-inflammatory drugs) to relieve pain and inflammation before considering corticosteroids.

There may be fewer side effects and less pain when corticosteroids are given through iontophoresis. Iontophoresis is a drug delivery method that uses an electrical current to move the drug through the skin into the tissue. Because this method is less painful than hypodermic needle delivery, some people may start rehabilitation sooner and experience faster pain relief.³

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Assendelft W, et al. (2005). Tennis elbow. Clinical Evidence (14): 1561–1569.

2. Smidt N, et al. (2002). Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: A randomised controlled trial. Lancet, 359(9307): 657–662.

3. Nirschl RP, et al. (2003). Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. American Journal of Sports Medicine, 31(2): 189–195.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	David Pichora, MD, FRCSC - Orthopedic Surgery
Last Updated	February 14, 2007