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Tennis elbow: cortisone, hyaluronic acid and botulinum toxin put to the test
A common treatment for epicondylitis radialis humeri, the so-called "tennis elbow", is the injection of cortisone, hyaluronic acid, botulinum toxin and other active ingredients. Researchers at Copenhagen University Hospital evaluated 17 randomized controlled trials (RCTs) involving just under 1,400 patients to examine the effectiveness of the tips. Her conclusion: The treatment lacks any scientific basis.
Tennis arm is triggered by overuse
A tennis arm is understood to be a painful irritation of the tendon attachments of the muscles of the forearm, which attach to the two bone protrusions above the joint on the humerus. The cause is an overuse of the forearm muscles, which is triggered either by severe overuse or by constant repetition of the overload. Often, one-sided stress, such as when using the computer mouse, incorrect posture, unfavorable posture during sleep, for example when the arm is used heavily bent as a headrest, or in racket sports such as golf or tennis is the cause of the disease. Another underlying disease such as fibromyalgia can also trigger the irritation of the muscles.
Therapy with syringes for tennis elbow is not recommended
According to Dr. Thøger Persson Krogh from Copenhagen University Hospital and his team include epicondylitis radialis humeri, colloquially known as a tennis elbow, among those diseases whose current treatment methods have so far been unable to prove their scientific effectiveness. With their evaluation, the scientists confirmed a study published in 2002 in The Lancet that came to a similar conclusion. At that time, patient data from general practice was analyzed. In 80 percent of cases, the symptoms subsided after a year.
For the study now published in the journal "The American Journal of Sports Medicine", the Danish researchers evaluated 17 randomized controlled studies with almost 1,400 patients and came to a clear result: the injection treatment with the investigated active ingredients is not recommended for "tennis elbow".
Cortisone not effective for tennis elbow?
In the meta-analysis, eight different common treatment methods for "tennis elbow" were examined. The researchers examined the effects of botulinum toxin, also known under the trade name Botox, sclerotherapy, glucocorticoids, autologous blood, platelet-rich plasma (PRP), as well as hyaluronic acid, polidocanol and glycosaminoglycan polysulfate. The result of the Danish researchers: After an average follow-up period of 32 weeks, the corticosteroid injections were no more effective than placebo against the pain. The situation was similar with polidocanol and cartilage protection with glycosaminoglycan polysulfate. Botulinum toxin performed slightly better than the placebo, but led to short-term paralysis in the fingers, so the Danish researchers rated the product as unsuitable for practice.
Autologous blood therapy helps with tennis elbow
Autologous blood therapy was significantly more effective than placebo. Sclerotherapy or proliferation therapy, in which a sugar-containing solution is injected under the skin, and injections with hyaluronic acid also helped better than the placebo. However, Krogh and colleagues complained that the studies included in the study were only partially meaningful, since some did not meet the Cochrane standards for low risk of bias due to the low number of subjects. In addition, only two teams of authors were able to demonstrate that they are independent of the company.
The positive result of the meta-analysis was that none of the patients had to stop treatment due to undesirable side effects or the like. The most uncomfortable therapeutic effects included pain at the injection site and, in rare cases, skin atrophies or pigment disorders after the injection of cortisone. (ag)
Image: Stephanie Hofschlaeger / pixelio.de