Effects of Heavy Slow Resistance Training Combined With Corticosteroid Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy: A 3-Arm Randomized Double-Blinded Placebo-Controlled Study

Abstract

Background: Lateral elbow tendinopathy is a disabling tendon overuse injury. It remains unknown if a corticosteroid injection (CSI) or tendon needling (TN) combined with heavy slow resistance (HSR) training is superior to HSR alone in treating lateral elbow tendinopathy. Purpose/Hypothesis: The purpose was to investigate the effects of HSR combined with either (1) a CSI, (2) TN, or (3) placebo needling (PN) as treatment for lateral elbow tendinopathy. We hypothesized that 12 weeks of HSR in combination with a CSI or TN would have superior effects compared with PN at 12, 26, and 52 (primary endpoint) weeks’ follow-up on primary (Disabilities of the Arm, Shoulder and Hand [DASH] score) and secondary outcomes in patients with chronic unilateral lateral elbow tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 60 patients with chronic unilateral lateral elbow tendinopathy were randomized to perform 12 weeks of home-based HSR with elastic band exercises combined with either (1) a CSI, (2) TN, or (3) PN, and at 12, 26, and 52 weeks, we assessed the primary outcome, the DASH score, and secondary outcomes: shortened version of the DASH (QuickDASH) score, pain (numerical rating scale [NRS] score), pain-free grip strength, and hypervascularization (power Doppler area). Results: A CSI, TN, and PN improved patient outcomes equally based on the DASH (Δ20 points), QuickDASH (Δ21 points), and NRS (Δ2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Δ–2251 pixels, P = .0418). Except for the QuickDASH score (CSI increased score by Δ15 points compared with PN; P = .0427), there were no differences between the groups after 52 weeks. Conclusion: These results suggest that 12 weeks of HSR improved symptoms in both the short and the long term and that a CSI or TN did not amplify this effect. In addition, a CSI seemed to impair patient-reported outcomes compared with HSR alone at long-term follow-up. Registration: NCT02521298 ( ClinicalTrials.gov identifier).

What’s New in Shoulder and Elbow Surgery

“…Altas x et al 36 compared a home exercise program alone (26 patients) with an exercise program combined with either kinesiotaping (26 patients) or dry nee-dling (26 patients) and found that the exercise program plus dry needling group performed the best overall at 3 weeks and 6 months, with the exercise program plus kinesiotaping and dry needling groups both having significantly better outcomes than the home exercise program alone. Couppé et al 37 compared patients randomized to receive a corticosteroid injection (21 patients), tendon needling (17 patients), or placebo needling (20 patients), followed by a home exercise program, and did not find an additional benefit from either the corticosteroid or tendon needling through 12 months.…”

Shoulder & Elbow

“…Researchers from Copenhagen (Denmark) have performed and reported one of the best pieces of evidence surrounding treatment in this common, but often recalcitrant, condition. 2 Their three-arm, randomized, double-blinded, placebo-controlled trial was designed to study corticosteroid and TN in conjunction with HSR, as compared with placebo needling (PN) and HSR. They hypothesized that injection or needle therapy would be superior compared to placebo.…”