Efficacy of corticosteroids in the treatment of lateral epicondylitis

Study Type: ACE Review
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
Synopsis
8 ACE Reports (7 randomized controlled trials and 1 systematic review and meta-analysis, n=694) from the OrthoEvidence database assessing the effectiveness of corticosteroid injections in comparison to control injections (either saline or local anesthesia) for the treatment of lateral epicondylitis were included in this review. The purpose of this review was to determine the impact of corticosteroid injections on pain and physical function in comparison to these control treatments. As such, information Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Sponsor: Conflicts:
Non-Industry funded Clinical Research Grant from the American Society for Surgery of the Hand. None disclosed
Funding: Sponsor: Conflicts:
Industry funded Wright Medical, AO Foundation, Smith and Nephew, Small Bone Innovation, Joint Active Systems, and Biomet None disclosed
Funding: Sponsor: Conflicts:
Industry funded Biomet Biologics Inc; Non-Industry funded: The Danish Rheumatism Association, Oak Foundation Other
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Oak Foundation, the Danish Rheumatism Association, the Research Foundation at Region Hospital Silkeborg, and Copenhagen University Hospital, Frederiksberg Other
Background
Lateral epicondylitis, commonly referred to as tennis elbow, is a painful elbow condition generated from work or non-work related overuse and involves the wear of the extensor tendon attached to the lateral epicondyle. Conservative treatment modalities for lateral epicondylitis range from physiotherapy to a number of injectable interventions, a common treatment being corticosteroid injections. However, conflicting evidence exists regarding the efficacy of the use of corticosteroid injections in the treatment of this disorder. Hence, this ACE review aimed to compare of corticosteroid injections against control injections (saline or local anesthesia) on pain and function in patients with lateral epicondylitis.
What was the principal research question?
Is the use of corticosteroid injections more effective than a control treatment (either saline or local anesthesia) for the improvement of pain and functional outcomes in patients with lateral epicondylitis measured up to 12 months?
Report Characteristics: 8 reports including 7 randomized controlled trials and 1 meta-analysis published within February 1991 to June 2013 were identified from the OrthoEvidence database that compared the use of corticosteroids to either saline or local anaesthesia for the treatment of lateral epicondylitis.
Report Selection: A search of the OrthoEvidence database included the following search terms: "corticosteroid", "glucocorticoid", "lateral epicondylitis" and "tennis elbow". The following are the inclusion criteria used in this review: 1) a comparison of the effects of a corticosteroid injection to a control injection (either a local anesthetic or a saline solution), 2) consisted of a population of patients with lateral epicondylitis (tennis elbow) and 3) evaluated pain and or functional disability in this patient population. Reports which also examined the efficacy of platelet-rich plasma injections were included provided there were also groups treated with corticosteroid and a control injection (either anesthetic or saline solution). Data on PRP injection efficacy was not extracted for this review.
Outcomes: Outcomes measured included pain using the Visual Analogue Scale (VAS), pain and functional disability using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, function using the Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score, grip strength measured in either kilograms or millimetres of mercury, tendon thickness measured ultrasonographically in millimetres, and recurrence rate
Heterogeneity: Heterogeneity was assessed by means of the l-squared statistic and the random effects model was used for the pooling of data
Report Details and Scores
CONTENT IS LOCKED
Pooling and Statistical Analysis
Main Findings
Forest Plot: VAS Pain Scores
Forest Plot: Quick DASH Scores
What should I remember most?
Implications for patient treatment and future research:
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
June 6, 2014
It is important to determine the effect of CS injections over the long-term
December 2, 2014
Great report