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Corticosteroid injections for lateral epicondylitis: a systematic review
Nynke Smidt1, Willem J J Assendelft, Daniëlle A W M van der Windt
1Institute for Research in Extramural Medicine, Vrije Universiteit, Faculty of Medicine, Van der Boechorststraat 7, Amsterdam, The Netherlands. n.smidtemgo@med.vu.nl
Pain
|April 5, 2002
Summary
Corticosteroid injections offer short-term pain relief for lateral epicondylitis (tennis elbow) but lack evidence for long-term effectiveness. High-quality studies are needed to confirm benefits for tennis elbow treatment.
Area of Science:
- Orthopedics
- Sports Medicine
- Pain Management
Background:
- Lateral epicondylitis, commonly known as tennis elbow, is a condition frequently managed with corticosteroid injections to alleviate pain and functional limitations.
- The efficacy of these injections remains a subject of ongoing research and clinical debate.
Purpose of the Study:
- To systematically review and synthesize the evidence from randomized controlled trials (RCTs) evaluating the effectiveness of corticosteroid injections for treating lateral epicondylitis.
- To assess the short-term, intermediate, and long-term outcomes associated with corticosteroid injections compared to various control interventions.
Main Methods:
- A comprehensive literature search was conducted across six databases, supplemented by reference tracking, to identify relevant RCTs.
- Two independent reviewers assessed study quality and extracted data. A best-evidence synthesis approach was employed, considering internal validity, statistical significance, clinical relevance, and statistical power.
- Data analysis included standardized mean differences for continuous outcomes and relative risks for dichotomous outcomes.
Main Results:
- Thirteen RCTs comprising 15 comparisons were included. The majority of studies exhibited poor internal validity.
- For short-term outcomes (≤6 weeks), corticosteroid injections demonstrated statistically significant and clinically relevant improvements in pain, global improvement, and grip strength compared to placebo, local anesthetics, and conservative treatments.
- No statistically significant or clinically relevant benefits were observed for intermediate (6 weeks–6 months) or long-term (>6 months) outcomes.
Conclusions:
- While corticosteroid injections show promise for short-term symptom relief in tennis elbow, the overall evidence is limited by the poor methodological quality of existing studies.
- There is a lack of demonstrated efficacy for intermediate and long-term recovery.
- Further high-quality, well-designed RCTs with robust intermediate and long-term follow-up are essential to definitively establish the effectiveness of corticosteroid injections for lateral epicondylitis.