Injection of Dexamethasone Versus Placebo for Lateral Elbow Pain: A Prospective, Double-Blind, Randomized Clinical Trial

Lindenhovius, Anneluuk L.C.; Henket, Marjolijn; Gilligan, Brendan P.; Lozano-Calderón, Santiago; Jupiter, Jesse B.; Ring, David

doi:10.1016/j.jhsa.2008.02.004

Cited by 96 publications

(76 citation statements)

References 46 publications

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“…56,60 One high-quality review 60 included 12 RCTs (1171 participants) examining the effect of GCIs on lateral epicondylitis. 38,40,50,116,118,[120][121][122][123][124][125][126] Severity of tennis elbow (mean pain score before treatment) was reported for six of the included studies and ranged from 49 to 83 on a visual analogue scale (VAS) score (0-100). Co-interventions were not mentioned.…”

Section: Glucocorticoid Injectionsmentioning

confidence: 99%

“…Three RCTs 118,123,128 comparing GCIs with placebo had conflicting results, with two RCTs GCI having a significant effect on reduction of pain in the short term. 123,128 Pooled analysis of all three RCTs found placebo to be favoured for pain relief in the intermediate term.…”

Section: Glucocorticoid Injections Compared With Placebomentioning

confidence: 99%

“…123,128 Pooled analysis of all three RCTs found placebo to be favoured for pain relief in the intermediate term. Evidence for this outcome was considered of low quality when we assessed it using the GRADE principles (see Table 12 and GRADE profiles in Appendix 4).…”

Section: Glucocorticoid Injections Compared With Placebomentioning

confidence: 99%

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What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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BackgroundLateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient’s social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year.ObjectivesThis systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET.Data sourcesA comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases.Methods and outcomesWe conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013.ResultsA total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified.LimitationsThe summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect.ConclusionsClinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments.Study registrationThis study is registered as PROSPERO CRD42013003593.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Glucocorticoid Injectionsmentioning

confidence: 99%

Section: Glucocorticoid Injections Compared With Placebomentioning

confidence: 99%

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What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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“…Skin depigmentation and subcutaneous atrophy have been reported in a number of articles, in one case requiring surgical excision of the subcutaneous injection material deposits (in a case of medial epicondylitis) [1,15,18,20,21,29,39]. The overall rate appears to be in the 1.5-5 % range, depending on the series.…”

Section: Complicationsmentioning

confidence: 98%

“…There were no significant differences between the groups in the grip strength, pain, or the DASH at 1-and 6-month follow up. This study was limited by a significant loss to follow up [18].…”

Section: Corticosteroids Vs Placebomentioning

confidence: 99%

Steroid Injections

Immerman¹,

Szabo²

2015

Tennis Elbow

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Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

Tang

Wang

et al. 2020

PM&R

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Objective To compare the effectiveness of platelet‐rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis. Type of Study Network meta‐analysis. Literature Survey Randomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library. Methodology Two researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2). Publication bias was evaluated by constructing contour‐enhanced funnel plots. Stata 15 software was applied for pairwise meta‐analysis and network meta‐analysis. To explore the efficacy between different follow‐up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term. Synthesis Twenty RCTs (n = 1271) were included in this network meta‐analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient‐Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short‐term period. For the long‐term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8). Conclusion PRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.

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Injection of Dexamethasone Versus Placebo for Lateral Elbow Pain: A Prospective, Double-Blind, Randomized Clinical Trial

Cited by 96 publications

References 46 publications

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Steroid Injections

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

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