Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

“…In a trial of patients with elbow enthesopathy, an average of four corticosteroid injections had a poorer long-term pain reduction than a single injection [15]. In tendinopathies, neuropeptides, calcitonin gene-related peptide, and substance P are found to increase, so perhaps corticosteroid effects are mediated primarily by analgesic pathways [14,20]. In light of this, there may be a threshold where the analgesic effects are outweighed by the deleterious effects of corticosteroids on the tendon tissue, which include collagen disorganization, decreased mechanical properties of tendon, and longterm harm to tendon tissue and cells [17].…”

CORR Insights®: Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

“…Another recent injection study [1] also failed to show a benefit in terms of complete recovery, 1-year recurrence, VAS scores, and pain and disability measures of a patient related tennis elbow evaluation at 1-year followup when comparing physiotherapy and corticosteroid treatment to physiotherapy and placebo injection.…”

“…Still, that does not negate the short-term benefits associated with treatments in terms of disability, lost productivity, and quality of life that these studies have also shown. And, importantly, long-term, population-based outcomes studies [1,3,4] fail to take this short-term benefit into account in their conclusions, leading to a defeatist attitude towards the treatment of this condition. The current study by Sayegh and Strauch pools data from 22 randomized, controlled trials and comes to a similar conclusion -treatment with nonsurgical modalities was not superior to observation or placebo.…”

Platelet-Rich Plasma Therapies in Lateral Epicondylitis: Are we Asking the Right Questions?

“…Lehner et al (2013) reported on the detrimental effects of bupivicaine on tendon tissue in animal studies, demonstrating that bupivicaine injection increased the tendon vulnerability to injury and overload stress [27]. The use of corticosteroid injections to treat various tendinopathies, while still commonplace in clinical practice, has been repeatedly challenged by authors [28]. It is logical to predict that an anti-inflammatory substance should confer no benefit in the treatment of a noninflammatory, degenerative condition.…”