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Corticosteroid Injection in Early Treatment of Lateral Epicondylitis

Newcomer, Karen L. MD; Laskowski, Edward R. MD; Idank, David M. DO; McLean, Timothy J. RPT; Egan, Kathleen S. PhM

Clinical Journal of Sport Medicine: October 2001 - Volume 11 - Issue 4 - pp 214-222
Clinical Investigations

Objective: To analyze whether a corticosteroid injection in combination with rehabilitation early in the course of lateral epicondylitis (LE) alters the outcome up to 6 months after injection compared with a control injection and rehabilitation.

Design: Randomized, controlled, double-blind study.

Setting: Sports medicine center in a tertiary care center.

Participants: ubjects with a diagnosis of LE whose symptoms had been present less than 4 weeks were included. Subjects were recruited by word of mouth and through advertising. The 39 subjects who were recruited were 18 to 65 years old.

Interventions: 19 subjects were randomized to receive rehabilitation and a sham injection, and 20 were randomized to receive rehabilitation and a corticosteroid injection. At 4 and 8 weeks, they were reevaluated and their treatment programs were modified, if indicated.

Main Outcome Measures: Outcome measurements were performed at baseline, 4 weeks, 8 weeks, and 6 months, and included a functional pain questionnaire and a visual analogue pain scale. Painless grip strength on the affected side and maximal grip strength bilaterally were measured at baseline, 4 weeks, and 8 weeks.

Results: There were no significant differences in outcome between the two groups with the exception of an improvement in the visual analogue pain scale in the corticosteroid group from 8 weeks to 6 months. Outcome measurements in both groups improved significantly over time; more than 80% of subjects reported improvements from baseline to 6 months for all scales.

Conclusion: 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.

Department of Physical Medicine and Rehabilitation, and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, U.S.A.

Received June 2000; accepted September 7, 2001.

Address correspondence and reprint requests to Karen L. Newcomer, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A. E-mail: newcomer.karen@mayo.edu

© 2001 Lippincott Williams & Wilkins, Inc.