Which is better for chronic tennis elbow: a steroid injection or injection with botulinum toxin? The clinic I'm going to offers both. I don't know how to decide.

Corticosteroid injections remain one of the most common first treatments for tennis elbow. The local injection of this anti-inflammatory can help reduce pain and restore function.

Doctors aren't sure why it works since there isn't any inflammation present in chronic tennis elbow. It may be a placebo effect, meaning the person would get just as much relief from an injection of saline or some other neutral agent. There's some thought that the needle puncture is the real treatment. Dry needling may be all that's needed.

Botulinum toxin type A or Botox has also been used for chronic tennis elbow with limited success. One study at the Wrightington Hospital in England showed no effect from Botox injection in a group of 20 chronic elbow pain patients. Twenty other patients got a placebo injection for comparison. There were no differences between the two groups in terms of pain, grip strength, and quality of life.