Is prednisone (corticosteroid) effective for treating lateral epicondylitis?

Prednisone for Lateral Epicondylitis

Prednisone (oral corticosteroid) is not recommended for lateral epicondylitis, as systemic corticosteroids have not been studied for this condition and local corticosteroid injections—while providing short-term relief—do not improve long-term outcomes and may weaken tendon tissue, increasing rupture risk. 1, 2, 3

Why Systemic Corticosteroids Are Not Appropriate

• No evidence exists for oral prednisone or other systemic corticosteroids in treating lateral epicondylitis (tennis elbow). 4
• The available corticosteroid data is limited to local injections only, not oral systemic therapy. 1, 2, 3
• Even local corticosteroid injections show problematic outcomes: they provide relief only in the acute phase (first 6 weeks) but demonstrate significantly worse outcomes at 12-26 weeks compared to placebo or wait-and-see approaches. 3

Evidence Against Corticosteroid Use in Lateral Epicondylitis

Short-Term vs Long-Term Outcomes

• Corticosteroid injections combined with physiotherapy showed 10.6 times greater odds of success at 6 weeks compared to control (NNT=3), but this benefit completely reversed by 12-26 weeks, with 91% lower odds of success (OR 0.09), representing a large negative effect (NNT=5 for harm). 3
• At 52 weeks, there was no significant difference between any treatment groups, indicating lateral epicondylitis is largely self-limiting with 75% of patients recovering within one year. 3
• One randomized trial found no difference between glucocorticoid injection, platelet-rich plasma, or saline at 3 months, with a 58% dropout rate indicating none of these injections adequately controlled symptoms. 5

Tissue Damage Concerns

• Corticosteroids inhibit healing and reduce tensile strength of tendon tissue, potentially predisposing to spontaneous rupture. 1, 2
• There are no evidence-based guidelines supporting local corticosteroid injections in tendinopathy, and deleterious effects occur when injected into tendon substance. 2
• Repeated glucocorticoid injections may cause articular cartilage changes, though serious adverse events are rare. 2

Recommended Treatment Algorithm Instead

First-Line Conservative Management (3-6 months)

• Relative rest: Avoid activities causing pain while maintaining some activity to prevent deconditioning. 1
• Ice therapy: 10-minute periods through wet towel for short-term pain relief and reduced inflammation. 1, 2
• NSAIDs: Topical NSAIDs are preferable to oral NSAIDs due to eliminated gastrointestinal hemorrhage risk. 1
• Eccentric strengthening exercises: Stimulate collagen production and guide normal collagen fiber alignment. 1
• Stretching exercises: Widely accepted for tendon rehabilitation. 1

Second-Line Options (if inadequate response after 6 weeks)

• Tennis elbow bands: May help unload tendons during activity, though limited supporting data exists. 1
• Therapeutic ultrasound: May decrease pain and increase collagen synthesis, though evidence is weak. 1
• Extracorporeal shock wave therapy (ESWT): Appears safe and effective but requires further research. 1, 6

Surgical Evaluation

• Consider referral after 3-6 months of well-managed conservative treatment if pain persists. 1, 2
• Surgical techniques include excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis. 1

Critical Pitfalls to Avoid

• Do not use corticosteroid injections for patients needing long-term improvement—only consider if rapid short-term relief (within 6 weeks) is absolutely necessary, with full understanding that symptoms will likely worsen at 12-26 weeks. 3
• Avoid multiple corticosteroid injections, which increase tissue weakening and tendon rupture risk. 2
• Do not prematurely return to aggravating activities—ensure adequate healing time before resuming repetitive wrist extension movements. 2
• Recognize that 80% of patients fully recover within 3-6 months with appropriate conservative treatment, making aggressive interventions unnecessary. 1

Key Clinical Pearls

• Lateral epicondylitis is 7-10 times more common than medial epicondylitis and involves the dominant arm 75% of the time. 1, 7
• Activities requiring repetitive wrist extension are the primary causative factor. 1, 7
• Physical examination reveals well-localized tenderness that reproduces activity-related pain. 1
• Plain radiography may show osteophyte formation, degenerative joint disease, loose bodies, or fractures. 1