Bisset tennis elbow trial

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.

Bisset L, Beller E, Jull G, et al. BMJ (Clinical research ed.) 2006 · PMID 17012266 · doi:10.1136/bmj.38961.584653.ae

Question

How do physiotherapy, corticosteroid injection and a wait-and-see approach compare for tennis elbow over one year?

Design

Single-blind randomised controlled trial in Australia with three parallel arms.

Patients

Adults with clinically diagnosed lateral epicondylalgia of at least six weeks' duration.

Intervention

Physiotherapy (elbow mobilisation with movement plus exercise) or corticosteroid injection

Comparison

Wait and see

Primary outcome

Global improvement, pain-free grip strength and assessor-rated severity at 6 weeks and 52 weeks

Key result

Injection gave the best short-term results at 6 weeks, but at 1 year it was significantly worse than physiotherapy and wait and see, with high recurrence. Physiotherapy was better than wait and see early on, with little difference by 1 year.

Limitations

Patients and therapists could not be blinded; physiotherapy protocol is specific and may not generalise.

Impact on practice

Established that steroid injection trades short-term gain for long-term relapse, and that most tennis elbow settles with time and physiotherapy.