Treating Lateral Epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review
Morten Olaussen, Oeystein Holmedal, Morten Lindbaek, Soeren Brage, Hiroko Solvang
Lateral Epicondylitis is otherwise known as “Tennis Elbow” is an overuse injury of the extensor tendons that join the forearm muscles to the lateral epicondyle of the humerus. This overuse injury is thought to affect the extensor carpi radialis brevis (ECRB) specifically. This injury is seen in patients with either excessive repetitive flexion with subsequent extension of their wrist such as in tennis players, improper form and/or improper equipment or even with a daily profession that requires manual labour with their hands.
Lateral Epicondylitis is generally thought to be a self-limiting injury but can take a long time to resolve. Common treatments used by family physicians and doctors who deal with sports injuries include rest, NSAIDS, physical therapy, deep friction massage, braces, acupuncture, extracorporeal shockwave therapy, cortisone injections, surgery as well as more recently platelet-rich plasma injections.
This article looked at the benefits of two of these treatment modalities: lateral elbow cortisone injection and non-electrotherapeutic physiotherapy. The authors did a systematic review, which included 11 randomized controlled trials, representing 1161 patients of both sexes and all ages. All of these studies looked at least at one treatment group and one control group which included receiving anything from no treatment, to common treatments such as counselling, rest, or NSAIDS. Some of the measures used to evaluate the efficacy of the treatments were pain, grip strength and overall improvement effect at 4, 12, 26 and 52 weeks of follow-up.
Overall, the results showed that corticosteroid injection provided patients with a short-term reduction in pain versus control groups. However, more notably corticosteroid injections resulted in an increase in pain, reduction in grip strength and negative effect on the overall improvement at the intermediate stage of follow-up. Manipulation and exercise in comparison to control showed improvement at short-term follow-up, but no significant difference at intermediate or long-term follow-up.
In all, this study reveals that corticosteroid injections may have a significant negative effect on the intermediate follow-up likely outweighs any of the short-term benefits. Manipulation and exercise and exercise and stretching have a short-term effect, with some evidence of longer-term effect.
Dr. Mickey Moroz M.D.C.M. CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (CAC SEM), Dip Sport & Exercise Med