Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow

J Sci Med Sport. 2017 Jun;20(6):528-533. doi: 10.1016/j.jsams.2016.10.010. Epub 2016 Oct 29.


Objectives: To compare three different ultrasound-guided injections for chronic tennis elbow.

Design: Assessor-blinded, randomized controlled comparative trial.

Methods: 44 patients with clinically diagnosed tennis elbow, confirmed by Doppler ultrasound, received under ultrasound guidance, a single corticosteroid injection (n=14), or two injections (separated by 4 weeks) of either autologous blood (n=14) or polidocanol (n=16). Clinical and ultrasound examination was performed at baseline, 4, 12 and 26 weeks.

Results: Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4 weeks (p<0.001, number needed to treat 1 (95% CI 1-2)). In contrast, at 26 weeks corticosteroid was significantly worse than polidocanol (p=0.004, number needed to harm 2 (1-6)). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p=0.007, number needed to harm 2 (1-4)). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4 weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12 weeks and reduced echogenicity and hyperaemia after 12 or 26 weeks respectively.

Conclusions: Injections of corticosteroid cannot be recommended over polidocanol or autologous blood, because despite beneficial short-term effect there were inferior long-term effects. Whether polidocanol or autologous blood injections are effective is unknown, especially as their global effect profiles are not unlike previously reported for wait-and-see.

Keywords: Blood products; Colour Doppler; Lateral epicondylalgia; Polidocanol; Ultrasonography.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Anti-Inflammatory Agents / therapeutic use*
  • Blood Transfusion, Autologous*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Polidocanol
  • Polyethylene Glycols / therapeutic use*
  • Sclerosing Solutions / therapeutic use*
  • Single-Blind Method
  • Tennis Elbow / diagnostic imaging
  • Tennis Elbow / therapy*
  • Treatment Outcome
  • Ultrasonography, Doppler, Color
  • Ultrasonography, Interventional


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Sclerosing Solutions
  • Polidocanol
  • Polyethylene Glycols