Corticosteroid injections for lateral epicondylitis: a systematic review

Abstract

Patients with lateral epicondylitis (tennis elbow) are frequently treated with corticosteroid injections, in order to relieve pain and diminish disability. The objective of this review was to evaluate the effectiveness of corticosteroid injections for lateral epicondylitis. Randomised controlled trials (RCTs) were identified by a highly sensitive search strategy in six databases in combination with reference tracking. Two independent reviewers selected and assessed the methodological quality of RCTs that included patients with lateral epicondylitis treated with corticosteroid injection(s), and reported at least one clinically relevant outcome measure. Standardised mean differences were computed for continuous data and relative risks (RR) for dichotomous data. A best-evidence synthesis was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power. Thirteen studies consisting of 15 comparisons were included in the review, evaluating the effects of corticosteroid injections compared to placebo injection (n=2), injection with local anaesthetic (n=5), another conservative treatment (n=5), or another corticosteroid injection (n=3). Almost all studies had poor internal validity scores. For short-term outcomes (<or=6 weeks), statistically significant and clinically relevant differences were found on pain, global improvement and grip strength for corticosteroid injection compared to placebo, local anaesthetic and conservative treatments. For intermediate (6 weeks-6 months) and long-term outcomes (>or=6 months), no statistically significant or clinically relevant results in favour of corticosteroid injections were found. Although the available evidence shows superior short-term effects of corticosteroid injections for lateral epicondylitis, it is not possible to draw firm conclusions on the effectiveness of injections, due to the lack of high quality studies. No beneficial effects were found for intermediate or long-term follow-up. More, better designed, conducted and reported RCTs with intermediate and long-term follow-up are needed.

Optimal case definitions of upper extremity disorder for use in the clinical treatment and referral of patients

“…However, this need for diagnostic refinement is likely to be limited, since the most recent Cochrane reviews have concluded that steroid injections, ultrasound, and acupuncture are of limited or uncertain benefit at the shoulder (15)(16)(17), and that acupuncture is of unproven benefit (19) and shockwave therapy is ineffective (21) for lateral elbow pain. On the other hand, recent non-Cochrane reviews do favor steroid injections over placebo as a treatment for lateral elbow pain with tenderness (25)(26)(27), further supporting the case for distinguishing patients in whom elbow pain is accompanied by tenderness.…”

“…For these purposes, we searched in Medline and Embase (from the last relevant Cochrane search date to June 2010) and in Google Scholar (first 300 hits in March 2010), combining terms for upper extremity disorder with those for RCTs. After elimination of duplicate references, these searches yielded 156 potentially relevant articles from Cochrane reviews and 189 other potentially relevant titles (including several that were cited in 4 non-Cochrane reviews [on steroid injections (25)(26)(27) and physiotherapy for epicondylitis (28)]) identified by the search.…”

Radiofrecuencia pulsada en el tratamiento de la epicondilitis

“…Clínicamente se caracteriza por la aparición de dolor a la palpación del cóndilo lateral que se agravan al realizar extensión o supinación de la muñeca contra resistencia. El tratamiento más común consiste en reposo, aplicación de frío en la fase aguda, AINE e infiltración de esteroides en fase de crónica, aunque sin dar una solución rápida y eficaz (1). La radiofrecuencia pulsada aplicada en estos casos, permite el tratamiento local de la zona lesionada favoreciendo la cicatrización y la modulación de la respuesta dolorosa al aplicarla sobre el nervio sensitivo de la zona (nervio cutáneo braquial lateral).…”

Evidence Based Data for Management of Lateral Epicondylitis: Review

“…KS se çi mi, doz ve mik ta rı ko nu sun da yi ne ye ter li veri ol ma dı ğı bil di ril miş tir. 25 ELEK TRO TE RA Pİ DI ŞIN DA Kİ TE DA Vİ LER Or tez…”

“…KS se çi mi, doz ve mik ta rı ko nu sun da yi ne ye ter li ve ri ol ma dı ğı bil di ril miş tir. 25 Or tez ler ile il gi li mev cut ça lış ma lar da kon trol grup la rı, so nuç öl çüm le ri, kul la nı lan or tez ti pi, yakın ma sü re si, prog nos tik fak tör le rin çe şit li li ği ve dü şük va ka sa yı la rı ne de niy le ke sin so nuç bil di rile me ye ce ği, bun la rın dik ka te alı na rak ya pıl dı ğı ça-lış ma la rın ge rek li li ği bil di ril miş tir. 17 De rin trans vers frik si yon ma sa jı nın et kin li ği ile il gi li ça lış ma lar da ki va ka sa yı sı az lı ğı ne de niy le so nuç çı kar tı la ma ya ca ğı be lir til miş tir.…”