Abstract
Introduction
This study seeks to compare two treatment methods of lateral epicondylitis: corticosteroid injection (CSI) and a local anesthetic injection (LAI).
Materials and methods
In this single-blinded randomized clinical trial, 138 patients with the diagnosis of lateral epicondylitis were assigned either into CSI group receiving methylprednisolone 1 ml (49 patients) or LAI group (51 patients) receiving procaine 1 ml 2 % in a single dose at the maximal point tenderness site. The primary outcome measure was elbow disability using Quick DASH, and secondary outcome measures were pain intensity using Visual Analogue Scale (VAS) and recurrence rate at pretreatment visit and at 3-, 6- and 12-week post-treatment visits.
Results
There were no significant differences between the patients in both groups for demographic factors including age, gender, dominant hand, involved hand, and work pressure. Before treatment, the patients in both groups were suffering from the same rates of elbow disability and pain as measured by Quick DASH and VAS, respectively, (p > 0.05). In general, the recovery rate (comparison between pretreatment visit and last post-treatment visit) was significantly more effective and higher in CSI than LAI. CSI was dramatically more effective at 3-week visit, but less and less effective at 6- and 12-week visits. At 12-week visit the recurrence rate was 34.7 % (17 patients) in CSI group.
Conclusion
For lateral epicondylitis, CSI has the best short-term treatment results yet the highest recurrent rates. The combination of CSI with other treatment option or with a change in injection technique from single injection to peppering injection may be promising.
Similar content being viewed by others
References
Coonrad RW, Hooper WR (1973) Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am 55(6):1177–1182
Gruchow HW, Pelletier D (1979) An epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies. Am J Sports Med 7(4):234–238
Nirschl RP (1992) Elbow tendinosis/tennis elbow. Clin Sports Med 11(4):851–870
Dimberg L (1987) The prevalence and causation of tennis elbow (lateral humeral epicondylitis) in a population of workers in an engineering industry. Ergonomics 30(3):573–579. doi:10.1080/00140138708969746
Walz DM, Newman JS, Konin GP, Ross G (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30(1):167–184. doi:10.1148/rg.301095078
Ollivierre CO, Nirschl RP (1996) Tennis elbow. Current concepts of treatment and rehabilitation. Sports Med 22(2):133–139
Assendelft WJ, Hay EM, Adshead R, Bouter LM (1996) Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract 46(405):209–216
Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF (2002) Time to abandon the “tendinitis” myth. BMJ (Clin res ed) 324(7338):626–627
Smidt N, Assendelft WJ, van der Windt DA, Hay EM, Buchbinder R, Bouter LM (2002) Corticosteroid injections for lateral epicondylitis: a systematic review. Pain 96(1–2):23–40
Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM (2002) Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 359(9307):657–662. doi:10.1016/S0140-6736(02)07811-X
Bunata RE, Brown DS, Capelo R (2007) Anatomic factors related to the cause of tennis elbow. J Bone Joint Surg Am 89(9):1955–1963. doi:10.2106/JBJS.F.00727
Dogramaci Y, Kalaci A, Savas N, Duman IG, Yanat AN (2009) Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial. Arch Orthop Trauma Surg 129(10):1409–1414. doi:10.1007/s00402-009-0832-x
Okcu G, Erkan S, Senturk M, Ozalp RT, Yercan HS (2012) Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial. Acta Orthop Traumatol Turc 46(1):26–29
Olaussen M, Holmedal O, Lindbaek M, Brage S (2009) Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: a protocol for a randomised, placebo-controlled study. BMC Musculoskelet Disord 10:152. doi:10.1186/1471-2474-10-152
Peterson M, Butler S, Eriksson M, Svardsudd K (2011) A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci 116(4):269–279. doi:10.3109/03009734.2011.600476
Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D (2009) A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med 43(7):471–481. doi:10.1136/bjsm.2008.052761
Stefanou A, Marshall N, Holdan W, Siddiqui A (2012) A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. J Hand Surg Am 37(1):104–109. doi:10.1016/j.jhsa.2011.10.005
Szabo RM (2009) Steroid injection for lateral epicondylitis. J Hand Surg Am 34(2):326–330. doi:10.1016/j.jhsa.2008.10.011
Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE (2011) Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am 36(8):1269–1272. doi:10.1016/j.jhsa.2011.05.014
Coombes BK, Bisset L, Connelly LB, Brooks P, Vicenzino B (2009) Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: a protocol for a randomised control trial with placebo comparison. BMC Musculoskelet Disord 10:76. doi:10.1186/1471-2474-10-76
Saccomanni B (2010) Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature. Curr Rev Musculoskelet Med 3(1–4):38–40. doi:10.1007/s12178-010-9066-3
Price R, Sinclair H, Heinrich I, Gibson T (1991) Local injection treatment of tennis elbow–hydrocortisone, triamcinolone and lignocaine compared. Br J Rheumatol 30(1):39–44
Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM (2010) Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord 11:206. doi:10.1186/1471-2474-11-206
Barr S, Cerisola FL, Blanchard V (2009) Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: a systematic review. Physiotherapy 95(4):251–265. doi:10.1016/j.physio.2009.05.002
Faro F, Wolf JM (2007) Lateral epicondylitis: review and current concepts. J Hand Surg Am 32(8):1271–1279. doi:10.1016/j.jhsa.2007.07.019
Hart L (2011) Corticosteroid and other injections in the management of tendinopathies: a review. Clin J Sport Med 21(6):540–541. doi:10.1097/01.jsm.0000407929.35973.b9
Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R (2012) Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. doi:10.1177/0363546512458237
Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH (1992) Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis. J Bone Joint Surg Br 74(5):646–651
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B (2006) Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ (Clin res ed) 333(7575):939. doi:10.1136/bmj.38961.584653.AE
Hay EM, Paterson SM, Lewis M, Hosie G, Croft P (1999) Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ (Clin res ed) 319(7215):964–968
Bellapianta J, Swartz F, Lisella J, Czajka J, Neff R, Uhl R (2011) Randomized prospective evaluation of injection techniques for the treatment of lateral epicondylitis. Orthopedics 34(11):e708–e712. doi:10.3928/01477447-20110922-13
Alfredson H, Ljung BO, Thorsen K, Lorentzon R (2000) In vivo investigation of ECRB tendons with microdialysis technique–no signs of inflammation but high amounts of glutamate in tennis elbow. Acta Orthop Scand 71(5):475–479. doi:10.1080/000164700317381162
Ljung BO, Alfredson H, Forsgren S (2004) Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus. Studies on tennis elbow and medial epicondylalgia. J Orthop Res 22(2):321–327. doi:10.1016/s0736-0266(03)00183-9
Ljung BO, Forsgren S, Friden J (1999) Substance P and calcitonin gene-related peptide expression at the extensor carpi radialis brevis muscle origin: implications for the etiology of tennis elbow. J Orthop Res 17(4):554–559. doi:10.1002/jor.1100170414
Bisset L, Smidt N, Van der Windt DA, Bouter LM, Jull G, Brooks P, Vicenzino B (2007) Conservative treatments for tennis elbow do subgroups of patients respond differently? Rheumatology (Oxford) 46(10):1601–1605. doi:10.1093/rheumatology/kem192
Conflict of interest
All named authors hereby declare that they have no conflicts of interest to disclose.
Ethical standards
Guilan University of Medical Sciences Ethics Committee approved the study (reference number: 1910051505) and it was registered on the Iranian Registry of Clinical Trials (IRCT no.: IRCT201205127274N4).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mardani-Kivi, M., Karimi-Mobarakeh, M., Karimi, A. et al. The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial. Arch Orthop Trauma Surg 133, 757–763 (2013). https://doi.org/10.1007/s00402-013-1721-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1721-x