Tennis Elbow and Cortisone Injections: What You Need to Know
Understanding Tennis Elbow
Tennis elbow, also called lateral epicondylitis, happens when the tendons on the outside of your elbow get irritated and painful. Despite the name, you don't need to play tennis to get it. I see patients in Durango every week who developed tennis elbow from activities like gardening, painting, or even using a computer mouse too much.
The condition affects the common extensor tendon, which connects your forearm muscles to the bony bump on the outside of your elbow. When this tendon gets overused or strained, it becomes inflamed and causes that familiar aching pain that gets worse when you grip things or twist your wrist.
For years, doctors - including myself early in my practice here in Durango - would often recommend cortisone injections as a quick fix for tennis elbow pain. The thinking made sense: cortisone reduces inflammation, and tennis elbow involves inflammation, so injecting cortisone should help, right? Well, it turns out the story is more complex than we first thought.
Why Cortisone Injections Seemed Like a Good Idea
When cortisone injections first became popular for tennis elbow, they seemed like a miracle treatment. Patients would come to my office in significant pain, get an injection, and feel much better within days. I remember one patient, a contractor from Pagosa Springs, who couldn't hold his hammer without wincing. After a cortisone injection, he was back to work the next week, pain-free.
The relief was real, but we started noticing something troubling. Many of these patients would return months later with the same problem, often worse than before. That contractor? He came back three times over two years, each time needing stronger treatment.
What Research Has Taught Us
Medical research has shown us why cortisone injections for tennis elbow can actually do more harm than good in the long run. Here's what we've learned:
Short-term relief, long-term problems: While cortisone can provide quick pain relief, studies show that patients who receive cortisone injections often have worse outcomes after six months compared to those who didn't get injections. The pain relief is temporary, but the underlying problem gets worse.
Tendon weakening: Cortisone doesn't just reduce inflammation - it can also weaken the tendon itself. Tennis elbow isn't just about inflammation; it's about the tendon breaking down and not healing properly. Cortisone can actually slow down the healing process and make the tendon more fragile.
Higher recurrence rates: Patients who receive cortisone injections for tennis elbow are more likely to have their symptoms return, often requiring more aggressive treatment later. This is the opposite of what we want to achieve.
The Real Problem with Tennis Elbow
We now understand that tennis elbow isn't simply an inflammatory condition that needs to be "cooled down" with cortisone. Instead, it's what we call a degenerative tendinopathy. This means the tendon has small tears and areas where the normal, healthy tendon tissue has been replaced with weaker, disorganized tissue.
Think of it like a rope that's starting to fray. You can't fix a fraying rope by just reducing swelling - you need to help the rope repair itself with stronger fibers. That's exactly what happens with tennis elbow treatment when we avoid cortisone and focus on helping the tendon heal properly.
Better Treatment Options
The good news is that we have much better treatments for tennis elbow now. In my practice at Animas Orthopedic Associates, I've seen excellent results with these approaches:
Physical therapy: A good physical therapist can teach you specific exercises that help the tendon heal properly. These aren't just stretches - they're carefully designed exercises that gradually load the tendon in a way that promotes healthy tissue growth.
Activity modification: Sometimes simple changes in how you perform daily activities can take pressure off the healing tendon. This might mean using different tools, changing your grip, or taking more frequent breaks.
Bracing: A tennis elbow brace can help reduce strain on the tendon during daily activities while it heals.
Platelet-rich plasma therapy: This newer treatment uses your own blood to promote healing. While still being studied, early results are promising for patients with stubborn cases of tennis elbow.
Time and patience: Most cases of tennis elbow will heal on their own with proper rest and gradual return to activity. This can take several months, but the results are usually much better than quick fixes.
When Surgery Might Be Needed
If non-operative treatments don't work after several months, surgery might be necessary. The good news is that tennis elbow surgery has a very high success rate when done for the right reasons. The procedure involves removing the damaged tendon tissue and promoting healthy healing.
I've performed many tendon repair surgeries for patients throughout the Four Corners area, including folks from Cortez, Farmington, and right here in Durango. Most patients return to their normal activities within a few months and have long-lasting relief.
What This Means for You
If you're dealing with tennis elbow, resist the urge to look for a quick fix. While cortisone injections might seem appealing because they can provide rapid pain relief, they're likely to make your problem worse in the long run.
Instead, work with your doctor to develop a comprehensive treatment plan that addresses the root cause of your tennis elbow. This might take longer, but you're much more likely to get lasting relief and return to the activities you love.
Remember, healing takes time, but it's worth doing it right the first time. Your elbow - and your future self - will thank you for choosing treatments that promote real healing rather than just masking the symptoms.
References
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461-469.
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-662.
Ahmad Z, Siddiqui N, Malik SS, Abdus-Samee M, Tytherleigh-Strong G, Rushton N. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95-B(9):1158-1164.
Krogh TP, Bartels EM, Ellingsen T, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013;41(6):1435-1446.
Dr. Brian Butzen is a double board-certified orthopedic surgeon specializing in shoulder, wrist and hand problems. He has been serving the Durango, Colorado community and surrounding Four Corners area since 2013 as part of Animas Orthopedic Associates, with a satellite clinic in Pagosa Springs, Colorado.