Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy

The aim of this review was to evaluate the current evidence for the effectiveness of corticosteroid injection and non-electrotherapeutic physiotherapy compared with control for treating lateral epicondylitis. The authors searched five databases in September 2012 for randomised controlled studies with a minimum quality rating. Of the 640 studies retrieved, 11 were included, representing 1161 patients of both sexes and all ages. The interventions administered were corticosteroid injection and non-electrotherapeutic physiotherapy. 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 served as outcome measures. Corticosteroid injection provided a short-term reduction in pain as opposed to no intervention or non-steroidal anti-inflammatory drugs (SMD -1.43, 95% CI -1.64 to -1.23). At intermediate follow-up, they 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)). The evidence regarding corticosteroid injection versus lidocaine injection was conflicting. At long-term follow-up, they did not find any 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. They found moderate evidence for short-term and long-term effects of eccentric exercise and stretching rather than no intervention. For exercise versus no intervention and eccentric or concentric exercise and stretching versus stretching alone, the authors found moderate evidence of no short-term effect.

 

The review found that corticosteroid injections provide short-term beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. Evidence regarding the long-term effect is conflicting. They also found that manipulation and exercise and exercise and stretching have a short-term effect, with exercise combined with stretching also having an effect in the long-term.

 

Targeted hip and knee strengthening

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