Ask Dr. Scofield: What Is the Best Treatment for Tennis Elbow?
Dr. Scofield discusses the benefits and risks of cortisone and PRP injections to treat tennis elbow.
Tennis elbow is a deceptive name for an elbow injury that usually has nothing to do with playing tennis. The injury occurs when the common extensor tendon attaching muscle at the elbow joint develops small tears. Over time, these tears can lead to painful inflammation and stress on other tissues in your arm. Symptoms include pain related to lifting and gripping.
The benefits and risks of cortisone treatments for tennis elbow
For decades, cortisone injections have been the standard treatment to relieve common extensor tendon pain. Sports medicine specialist Dr. Kirk Scofield explains that cortisone injections are still frequently used to relieve pain. However, emerging regenerative medicine treatments are another option patients can discuss with their orthopedic specialist.
“The traditional treatment for lateral epicondylitis, or tennis elbow, is to use physical therapy followed by a cortisone injection to relieve pain,” Dr. Scofield explains. “Cortisone injections are popular because they’ve been used for decades, they are affordable, and insurance covers them. Cortisone works by calming the nerves in the injured area. However, although cortisone provides effective short-term pain relief, it can’t heal the underlying tendon damage. Pain relief can be a helpful step on the road to healing and recovery. But that relief is temporary. In fact, we have good evidence showing that a cortisone injection gives people about three months of benefit.”
How cortisone injections work to relieve tennis elbow pain
“Unfortunately, the effectiveness of cortisone is a double-edged sword,” continues Dr. Scofield. “It makes you feel really good, but that feeling is not going to last. And when the relief wears off, you are going to want it back. The potential risks of cortisone treatment come with the repetition of injections over time.
“Because of the way cortisone works, repeated shots over time can degrade tendon tissue,” he explains. “Tendons have the highest tensile strength of all the connective tissue, thanks to the high proportion of collagen in tendon fibers. But cortisone works by shutting down collagen production in the tendon cells. As a result, when you get a cortisone shot, your tendon tissue stops making new collagen.”
Potential risks of long-term cortisone treatment
Several studies have examined the effect of cortisone on tendon tissue health over time. “One study compared two patient groups,” explains Dr. Scofield. “One group was given cortisone to relieve tennis elbow pain; the other group got no pain treatment. A year later, analysis suggested that the group who got the cortisone was worse off than the untreated group. Although the research we have is not robust enough to be definitive, there is significant data to show that doing repeated cortisone shots in the common extensor tendon is not the best idea.
“This does not mean that you should never get a cortisone shot,” says Dr. Scofield. “But understand that cortisone is going to make you feel better for a short period of time. You’ll have great pain relief right after the shot, but if you repeat injections over time, you’ll get diminishing returns. In addition, if you persist with cortisone shots to keep pain at bay, you risk weakening your tendon permanently.”
Benefits and risks of PRP treatment for tennis elbow
Unlike cortisone treatments to provide pain relief, platelet rich plasma (PRP) treatments are used to try to heal the injured tendons. “There’s a clear benefit dichotomy between trying to heal a tendon with PRP versus making it feel better for a while with cortisone,” notes Dr. Scofield. “However, because PRP is an emerging treatment that has yet to be FDA-approved, it is not covered by insurance. In addition, because PRP uses your own platelets to repair injury, treatment results are going to vary from patient to patient.”
How PRP injections work
“We draw patient blood and extract platelets from that blood for the PRP injection,” says Dr. Scofield. “Everyone’s body is different, so each patient is going to have a slightly different PRP. For example, some people have over 300,000 platelets per microliter. Others have 120,000 platelets per microliter. That variation is normal, and has an impact on the effectiveness of the treatment. Age is another factor. If you’re young, you probably have more robust platelets than older patients. Because there are so many factors at play, I encourage patients to discuss all of their treatment options with a regenerative medicine specialist.”
Consider all treatment options with a regenerative medicine specialist
“I think cortisone has a place,” states Dr. Scofield. “I would tell you that cortisone is a good option if you are planning a three-week biking tour in Europe and you want to be pain-free during your trip. Cortisone is great for that objective. Or if you’ve come back from your trip and all that exercise triggered a pain flare-up, we can use cortisone for temporary relief. It’s also a good general diagnostic tool to rapidly help us identify a pain generator in a joint. These are three situations where I think cortisone is helpful. However, I limit my use of cortisone to manage tennis elbow pain because of the potential long-term risks. For ongoing tennis elbow pain, there may be better treatment options to consider.”
Summit Orthopedics offers comprehensive sports medicine expertise
From Olympians to pro athletes to kids in youth sports and those that just want to be more active—Summit Orthopedics delivers expert care by fellowship-trained sports medicine physicians. If you are recently injured or concerned about ongoing pain, Summit Orthopedics sports medicine specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely help you get back to being active.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as several additional community clinics.
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