Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review

The objective of this study was to compare the effectiveness of corticosteroid injections with physiotherapeutic interventions for the treatment of lateral epicondylitis (tennis elbow).  Five RCTs were identified and included in the review. Four of the studies included the measurement of pain-free grip strength. Standardised mean differences (effect sizes) were calculated for this outcome measure and assessor’s rating of severity at 3, 6, 12, 26 and 52 weeks for two of the RCTs. Large effect sizes were demonstrated in favour of corticosteroid injections at short-term follow-up. At intermediate- and long-term follow-up, medium-to-large effect sizes were demonstrated in favour of physiotherapeutic interventions compared with corticosteroid injections. However, at long-term follow-up, the research suggests that there is a small benefit of physiotherapeutic interventions compared with a ‘wait and see’ policy.

Overall, the findings indicated that corticosteroid injections are effective at short-term follow-up, and physiotherapeutic interventions are effective at intermediate- and long-term follow-up. However, due to the limited number of high-quality RCTs and differences in the interventions and outcomes utilised within each of the included studies, any conclusions drawn must be interpreted with caution.

Steven Barr, Frances L. Cerisola and Victoria Blanchard. Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review. Physiotherapy, Volume 95, Issue 4, December 2009, Pages 251-265

Therapeutic Interventions for the Shoulder

Explore evidence-based interventions for shoulder pain including the Shoulder Symptom Modification Procedure and prescription considerations. Covers clinical approaches to management of specific conditions including instability, rotator cuff and subacromial pain.