Corticosteroid Injection in Early Treatment of Lateral Epicondylitis

Newcomer, Kathryn E.; Laskowski, Edward R.; Idank, David; McLean, Timothy J.; Egan, Kathleen S.

doi:10.1097/00042752-200110000-00002

Cited by 122 publications

(72 citation statements)

References 18 publications

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“…A total of four RCTs of variable quality (125 participants) were included in the review. 112,115,118,119 Only two RCTs were judged to be of sufficient quality to be considered in this overview. 112,118 Neither severity of lateral epicondylitis nor details of co-interventions were reported in any of the studies.…”

Section: Exercisesmentioning

confidence: 99%

“…56,60 One high-quality review 60 included 12 RCTs (1171 participants) examining the effect of GCIs on lateral epicondylitis. 38,40,50,116,118,[120][121][122][123][124][125][126] Severity of tennis elbow (mean pain score before treatment) was reported for six of the included studies and ranged from 49 to 83 on a visual analogue scale (VAS) score (0-100). Co-interventions were not mentioned.…”

Section: Glucocorticoid Injectionsmentioning

confidence: 99%

“…Three RCTs 118,123,128 comparing GCIs with placebo had conflicting results, with two RCTs GCI having a significant effect on reduction of pain in the short term. 123,128 Pooled analysis of all three RCTs found placebo to be favoured for pain relief in the intermediate term.…”

Section: Glucocorticoid Injections Compared With Placebomentioning

confidence: 99%

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What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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BackgroundLateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient’s social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year.ObjectivesThis systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET.Data sourcesA comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases.Methods and outcomesWe conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013.ResultsA total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified.LimitationsThe summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect.ConclusionsClinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments.Study registrationThis study is registered as PROSPERO CRD42013003593.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Exercisesmentioning

confidence: 99%

Section: Glucocorticoid Injectionsmentioning

confidence: 99%

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What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

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“…15,20 Furthermore, a corticosteroid injection early in the course of LE (less than 4 weeks) does not significantly change the outcome at 4 weeks, 8 weeks, or 6 months. 21 A recent systematic review 2 exploring the effectiveness of electrophysical modalities for treatment of LE has shown that there is moderate evidence for effectiveness of ultrasonography (protocol obtain from the original study: 1 MHz, 1:4, 1 W/cm 2 , 10 minutes per session, 2 to 3 times weekly, for a total of 10 treatments) 22 vs placebo in the medium term. There is limited evidence for the effectiveness of noxious-level electrical stimulation over tender points or low-or high-frequency transcutaneous electrical nerve stimulation on acupuncture points vs, respectively, placebo and sham transcutaneous electrical nerve stimulation in the short term (2 weeks).…”

Section: Managementmentioning

confidence: 99%

Humeral Lateral Epicondylitis Complicated by Hydroxyapatite Dihydrite Deposition Disease: A Case Report

Marchand

O’Shaughnessy

Descarreaux

2014

Journal of Chiropractic Medicine

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Objective: The aim of this case report is to differentiate the recovery timeline expected for patients with simple lateral epicondylitis from an abnormal recovery period, in which case an underlying condition should be suspected. Clinical features: A 49-year-old woman presented to a chiropractic clinic with posterolateral right elbow pain. The history included chronic recurrent lateral elbow pain, followed by a traumatic event leading to sustained pain and disability. Intervention and outcomes: Following a trial of conservative therapy including activity restrictions, soft tissue therapy, joint mobilizations, and therapeutic ultrasonography that led to no significant improvement, the patient was referred for diagnostic imaging that revealed hydroxyapatite dihydrite deposition disease. Conclusion: This report describes a case for which lateral epicondylitis symptoms failed to resolve because of an underlying condition (hydroxyapatite dihydrite deposition disease). This case emphasizes that primary care practitioners treating lateral epicondylitis should consider referral for further investigations when positive results are not achieved.

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“…11 There is no supportive evidence either topical or oral NSAIDS are the treatment option for common extensor tendinopathy. Pattanittum et al 2013 reviewed 15 trials comparing topical NSAIDs or oral NSAIDS versus placebo.…”

Section: Discussionmentioning

confidence: 99%

Lateral Epicondyle Tendinopathy; Comparison of Ulnar Medial-Lateral Glide and Radius Anterior Glide for Improving

Arif¹,

Sharif²,

Khalid³

2017

TPMJ

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Corticosteroid Injection in Early Treatment of Lateral Epicondylitis

Abstract: A corticosteroid injection does not provide a clinically significant improvement in the outcome of LE, and rehabilitation should be the first line of treatment in patients with a short duration of symptoms.

Cited by 122 publications

References 18 publications

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Humeral Lateral Epicondylitis Complicated by Hydroxyapatite Dihydrite Deposition Disease: A Case Report

Lateral Epicondyle Tendinopathy; Comparison of Ulnar Medial-Lateral Glide and Radius Anterior Glide for Improving

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