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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 - p 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:

© 2001 Lippincott Williams & Wilkins, Inc.