Perceived Pain Severity and Disability After the Recurrence of Tennis Elbow Following a Local Corticosteroid Injection

We hypothesized that there is no difference in the perceived pain and disability when the tennis elbow symptoms recur after a CSI. Consequently, we secondarily aimed to assess the approximate time from CSI until symptom recurrence. Moreover, we aimed to evaluate factors associated with the time to recurrence.

This cross-sectional study was performed during 2018-2019. We enrolled 50 consecutive patients who presented with the recurrence of tennis elbow symptoms and had a history of a single CSI for this condition. We asked the patients to rate the perceived pain and disability by filling the QuickDASH twice, including one by recalling pain and function before the CSI and one for the recent recurrent symptoms to assess the patient’s perceived pain and disability at the two-time points. 

There was a significant difference in perceived pain VAS and disability QuickDASH between pre-injection and recurrence, showing that the patient’s perceived pain and disability were greater when recurred (P<0.001). The mean time between CSI and recurrence of symptoms was 6 (4-7) months, which is shorter than the expected spontaneous resolution of tennis elbow (> 1 year) to offer other invasive treatments. Time to recurrence had no significant association with sex, age, side, education, occupation, pre-injection VAS score, pre-injection QuickDASH, or symptom duration using a linear regression model.

Although CSI seems to relieve or mask the pain in the short term, there is a considerable chance of recurrence, and patients may perceive more significant pain and disability that may lead to subsequent injection or precocious surgery. Time is an effective treatment for this illness. Shared decision-making is paramount, and patients have to be counseled regarding the natural history and expected prognosis of different treatments. Level of evidence: IV