Deflazacort Is Not Recommended for Tennis Elbow Treatment
Corticosteroid injections, including deflazacort, should be used with caution in tennis elbow as they may provide short-term relief but can inhibit healing, reduce tendon strength, and potentially lead to spontaneous rupture. 1
First-Line Treatment Options for Tennis Elbow
- Conservative management should be the initial approach for tennis elbow, focusing on relative rest while avoiding complete immobilization to prevent muscular atrophy 1, 2
- Activities that don't worsen pain may be continued, but those that aggravate symptoms should be modified or temporarily stopped 2
- Cryotherapy (ice application) for 10-minute periods through a wet towel provides effective short-term pain relief 1, 2
- NSAIDs (oral or topical) effectively relieve pain, with topical NSAIDs reducing tendon pain while avoiding gastrointestinal risks 1, 2
- Counterforce bracing/orthotics (tennis elbow bands) help reinforce, unload, and protect tendons during activity 1, 2
- Eccentric strengthening exercises and stretching are beneficial for promoting tendon healing and increasing strength 1, 2
Second-Line Treatment Options
- Locally injected corticosteroids may provide short-term relief but do not alter long-term outcomes 1, 2
- Corticosteroid injections should be used with caution as they may inhibit healing and reduce tendon tensile strength 1
- Therapeutic ultrasound may decrease pain and increase collagen synthesis, though evidence for consistent benefit is weak 1, 2
- Extracorporeal shock wave therapy (ESWT) appears safe and effective but requires further research 1, 2
Concerns with Corticosteroid Use in Tennis Elbow
- No evidence-based guidelines support the use of local corticosteroid injections in tendinopathy 1
- Corticosteroids may inhibit healing and reduce the tensile strength of the tissue, predisposing to spontaneous rupture 1
- Recent high-quality evidence suggests corticosteroids may delay recovery in tennis elbow 3
- A randomized controlled trial showed that corticosteroid injections had significantly better effects at six weeks but with high recurrence rates (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy 4
Treatment Algorithm
- Initial phase (0-4 weeks): Rest, activity modification, ice application, NSAIDs, and bracing 1, 2
- Rehabilitation phase (2-8 weeks): Progressive eccentric strengthening exercises, stretching, and continued bracing as needed 2
- For persistent symptoms: Consider second-line modalities but use corticosteroids with caution 1, 2
- For refractory cases (>6-12 months): Surgical consultation may be warranted 2, 5
Common Pitfalls and Caveats
- Overreliance on corticosteroid injections may lead to tendon weakening and potential rupture 2
- Complete immobilization should be avoided as it leads to muscle atrophy and deconditioning 1, 2
- Tennis elbow is self-limited, with approximately 80% of cases resolving with conservative management 5
- Advice with a "wait and see" approach is recommended as first-line treatment in primary care for most cases 6