Programme no. 229-OP
Treating Lateral Epicondylitis with Corticosteroid Injections or Non-electrotherapeutical Physiotherapy: a systematic review
Morten Olaussen*1, Søren Brage2, Øystein Holmedal3, Hiroko Solvang4, Morten Lindbæk5
1Department of General Practice, Institute of Health and Society,University of Oslo,Oslo,Norway, 2Department of Community Health,University of Oslo,Oslo,Norway, 3Department of General Practice, Institute of Health and Society,University of Oslo,Oslo,Norway, 4Department of General Practice, Institute of Health and Society,University of Oslo,Oslo,Norway, 5Department of General Practice, Institute of Health and Society,University of Oslo,Oslo,Norway
* = Presenting author
Objectives: To evaluate the current evidence for the efficacy of corticosteroid injection and non-electrotherapeutic physiotherapy compared with control for treating lateral epicondylitis.
Background: Lateral epicondylitis of the elbow is a frequent complaint in general practice. Often resolving in 6–12 months regardless of treatment, complaints may last up to 2 years. There is no consensus of which of many treatments to recommend. Previous reviews have found few studies on physiotherapy and conflicting results on the long-term effect of corticosteroid injection.
Results: Of 640 studies retrieved in the searches, 11 were included, representing 1161 patients of both sexes and all ages.
Corticosteroid injection gave a short-term reduction in pain versus no intervention or non-steroidal anti-inflammatory drugs (SMD −1.43, 95% CI −1.64 to −1.23). At intermediate follow-up, we found an increase in pain (SMD 0.32, 95% CI 0.13 to 0.51), reduction in grip strength (SMD −0.48, 95% CI −0.73 to −0.24) and negative effect on the overall improvement effect (RR 0.66 (0.53 to 0.81)). For corticosteroid injection versus lidocaine injection, the evidence was conflicting. At long-term follow-up, there was no difference on overall improvement and grip strength, with conflicting evidence for pain. Manipulation and exercise versus no intervention showed beneficial effect at short-term follow-up (overall improvement RR 2.75, 95% CI 1.30 to 5.82), but no significant difference at intermediate or long-term follow-up. We found moderate evidence for short-term and long-term effects of eccentric exercise and stretching versus no intervention. For exercise versus no intervention and eccentric or concentric exercise and stretching versus stretching alone, we found moderate evidence of no short-term effect.
Material/Methods: We performed a systematic review by searching five databases in September 2012 for randomised controlled studies with a minimum quality rating investigating treatments with corticosteroid injection or non-electrotherapeutic physiotherapy. Outcome measures were relative risk (RR) or standardised mean difference (SMD) for overall improvement, pain and grip strength at 4–12, 26 and 52 weeks of follow-up.
Conclusion: Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. Evidence on the long-term effect is conflicting. Manipulation and exercise and exercise and stretching have a short-term effect, with the latter also having a long-term effect.
Points for discussion: Is lateral epicondylitis usually treated by general practitioners in the Scandinavian countries? What are the main treatment challenges? To what extent are corticosteroid injections used? Is there a difference between acute and chronic lateral epicondylitis?