Tennis-Elbow (Epicondylalgia Externa) Treatment With Hydrocortisone

Quin, C. E.; Binks, F. A.

doi:10.1016/s0140-6736(54)91827-9

Cited by 14 publications

(3 citation statements)

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“…Many physicians regard tennis elbow as a benign selflimiting condition, which improves with or without treatment within 8 to 12 months (Cyriax 1936;Quin and Binks 1954;Bailey and Brock 1957). Our study shows that for a selected group of patients it may be the source of prolonged pain and persistent impairment of activities for many months.…”

Section: Discussionmentioning

confidence: 99%

“…Local corticosteroid injections and physiotherapy are common treatments. Several authors have reported the effectiveness of the former but after the initial reduction or disappearance of the symptoms some patients have had recurrence of pain (Freeland and Gribble 1954;Murley 1954;Quin and Binks 1954;Young, Ward and Henderson 1954;Bailey and Brock 1957;Day, Govindasamy and Patnaik 1978). In many studies the results of physiotherapy were no better than those of placebo treatment (Devereaux, Hazleman and Thomas 1985;Lundeberg, Haker and Thomas 1987;Chard and Hazleman 1988;Lundeberg, Abrahamsson and Haker 1988).…”

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confidence: 99%

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Local Corticosteroid Injection Versus Cyriax-Type Physiotherapy for Tennis Elbow

Verhaar

Walenkamp

Mameren³

et al. 1996

The Journal of Bone and Joint Surgery. British volume

125

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We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow. The main outcome measures were the severity of pain, pain provoked by resisted dorsiflexion of the wrist, and patient satisfaction.At six weeks 22 of 53 patients in the injection group were free from pain compared with only three in the physiotherapy group. In the corticosteroid-treated group 26 patients had no pain on resisted dorsiflexion of the wrist compared with only three in the physiotherapy group. Thirty-five patients who had injections and 14 who had physiotherapy were satisfied with the outcome of treatment at six weeks. At the final assessment there were 18 excellent and 18 good results in the corticosteroid group and one excellent and 12 good results in the physiotherapy group. There was a significant increase in grip strength in both groups but those with injections had a significantly better result.After one year there were no significant differences between the two groups. Half of the patients, however, had received only the initial treatment, 20% had had combined therapy and 30% had had surgery.We conclude that at six weeks, treatment with corticosteroid injections was more effective than Cyriax physiotherapy and we recommend it because of its rapid action, reduction of pain and absence of side-effects. Cyriax (1936, 1982) claimed substantial success for using local friction in combination with Mills' manipulations. There have been no comparative studies of these forms of treatment.Our aim was to compare the outcome and side-effects of treatment with local corticosteroids with physiotherapy as described by Cyriax. PATIENTS AND METHODSFor one year all patients with tennis elbow referred to the University Hospital, Maastricht were included in our study. The criteria for entry were pain on the lateral side of the elbow, tenderness over the forearm extensor origin, and pain on the lateral epicondyle during resisted dorsiflexion of the wrist with the elbow in full extension. Patients were excluded if they had had a previous operation on the lateral side of the elbow, or had arthritis or allied conditions, neurological disorders of the painful extremity, more than three local corticosteroid injections during the six months before consultation, and if the same elbow had been treated before by Cyriax's methods.In those with bilateral symptoms only the most painful arm was included. The patients were randomised into two groups using sealed numbered envelopes without strata or blocks. For ethical reasons we did not continue the randomised treatment if the results were unsuccessful.There were 106 patients (59 men and 47 women) with a mean age of 43 years (SD 9). Physical examination consisted of inspection, measurement of range of movement of the elbow, and assessment of the pain provoked by resisted movement and palpation. The mean duration of the symp-

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Local Corticosteroid Injection Versus Cyriax-Type Physiotherapy for Tennis Elbow

Verhaar

Walenkamp

Mameren³

et al. 1996

The Journal of Bone and Joint Surgery. British volume

125

View full text Add to dashboard Cite

show abstract

“…It was not until the 1950s that the injection of corticosteroids was first reported.44.54. 55 Freeland and Gribble found that hydrocortisone was neither more nor less effective than procaine and concluded that the short-term relief of pain was a non-specific response that may be due to the volume of fluid injected or to the trauma of introducing the needle.54 Subsequently a number of studies have shown steroids to be beneficial and this has remained one of the mainstays of conservative treatment.s"5R In this study, we found that 67% of patients presenting de now with tennis elbow received relief with steroid injections either alone or in combination with a tennis elbow band or non-steroidal anti-inflammatory drugs. The use of either a tennis elbow band or non-steroidal anti-inflammatory drugs with injected steroids made no statistical difference to the outcome.…”

Section: Discussionmentioning

confidence: 99%

Conservative and Surgical Treatment of Tennis Elbow: A Study of Outcome

Thurston¹

1998

Australian and New Zealand Journal of Surgery

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Background: Tennis elbow is one of the most common lesions of the arm. The first description is attributed to Runge in I873 but the name derives from 'Lawn Tennis Arm' described by Morris in 1882. The majority of cases are believed to be caused by a musculo-tendinous lesion of the common extensor origin at or near the attachment to the lateral epicondyle. While there are some comprehensive reports in the literature of patients treated by one technique or another, there are no comprehensive reports of groups of patients for whom various techniques were employed in a logical sequence until a resolution was reached. Methods: This paper presents a retrospective analysis of case notes and an analysis of questionnaires completed by the patients. Results: In this study we found that 67% of patients who presented with tennis elbow received relief through steroid injections either alone or in combination with a tennis elbow band or nonsteroidal anti-inflammatory drugs. The use of either a tennis elbow band or non-steroidal anti-inflammatory drugs or injected steroids made no statistical difference to the outcome. Conclusions: We also found that the patients who did not respond adequately to conservative measures were relieved of their symptoms by surgery.

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