Cortisone injection with anesthetic additives for radial epicondylalgia (tennis elbow)

In a prospective, randomized, double-blind study of radial epicondylalgia (tennis elbow), 109 patients with an average symptom duration of 8 months were considered for treatment with a single 1-mL injection of the steroid triamcinolone combined with either lidocaine or bupivacaine. The patients received clinical examinations at regular intervals for 1 year, and followup included visual analog pain scale and questionnaires. The 2 groups were comparable and for many factors distributed completely evenly with respect to gender, age, symptom duration, side dominance, type of pain onset, earlier treatment, and occupational loading. The only difference between the groups receiving lidocaine or bupivacaine was found at 2 weeks, when the bupivacaine additive yielded a better outcome for patients who had not been treated in any way before, for those with a short history of epicondylalgia, or both. The steroid injection treatment, regardless of which local anesthetic was given, presented a typical pattern, with symptoms relieved quickly by 2 weeks and then deterioration for many patients at 3 months, indicating a tendency to recurrence. A considerable loss of patients to other treatments at the 1-year followup indicated an equivocal long-term result. Patients who had not been treated earlier in any way had a more favorable prognosis, as did those with a history of epicondylalgia to 3 months.