Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial

Doğramacı, Yunus; Kalacı, Aydıner; Savaş, Nazan; Duman, İbrahim; Yanat, Ahmet Nedim

doi:10.1007/s00402-009-0832-x

Cited by 30 publications

(26 citation statements)

References 21 publications

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“…18,[167][168][169][170][172][173][174][175][176][177][178][179][180][181][182][183][184][185][188][189][190][191][192][193][194][195][196][197][198] The majority of studies had small sample sizes (≤ 50 participants, n = 18; 51-100 participants, n = 15; > 100 participants, n = 3).…”

Section: Randomised Controlled Trials Not Included In An Existing Sysmentioning

confidence: 99%

“…However, given the need to update the systematic reviews on which these findings are based, 56,60 and the subsequent publication of 10 new RCTs, 165,168,169,173,176,181,183,184,191,193 the overall level of evidence, as determined using the GRADE principles, is low (see Table 24). All of the subsequent RCTs were head-to-head comparisons, and all but one study (Gosens et al,…”

Section: Glucocorticoid Injectionsmentioning

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: Randomised Controlled Trials Not Included In An Existing Sysmentioning

confidence: 99%

Section: Glucocorticoid Injectionsmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…In most previous studies on injection therapy in LE, the injections are performed manually and without ultrasound guidance [5,7,12,14,[19][20][21]. Therefore, the exact location of infiltration in these studies is unknown.…”

Section: Discussionmentioning

confidence: 99%

Injection of tennis elbow: Hit and miss? A cadaveric study of injection accuracy

Keijsers

Bekerom²,

Koenraadt

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Bellapianta et al performed a prospective randomized study comparing the two methods, and it appeared that single-injection outperformed the peppered technique; however the study was underpowered, was not blinded, and had a high loss of follow up [26]. This is weighed against other prospective randomized trials showing improved disabilities of the arm, shoulder, and hand (DASH) scores, pain levels, and clinical assessment scores in groups treated with a peppering injection technique [19,27]. The hypothesized mechanism of action of the peppering technique involves the stimulation of bleeding and creation of multiple channels in the degenerated myxoid tissue at the lateral epicondyle, in order to stimulate healing.…”

Section: Corticosteroid Formulations and Injection Techniquesmentioning

confidence: 90%

Steroid Injections

Immerman¹,

Szabo²

2015

Tennis Elbow

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Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial

Abstract: In the treatment of lateral epicondilitis, combination of corticosteroid injections with peppering is more effective than corticosteroid injections or peppering injections alone and produces better clinical results.

Cited by 30 publications

References 21 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

Injection of tennis elbow: Hit and miss? A cadaveric study of injection accuracy

Steroid Injections

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