A comparison between corticosteroid injection versus local anaesthetic in treatment of lateral epicondylitis

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 pre-treatment visit and at 3-, 6- and 12-week post-treatment visits.

Results: There were no signi?cant 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 signi?cantly 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.

Keywords Tennis elbow Lateral epicondylitis Intra-lesional injection Corticosteroids Local anesthetic, Visual analogue scale Treatment outcome