Short or long term advantage seen with steroids, physiotherapy for lateral epicondylitis

NEW YORK (Reuters Health) – While corticosteroid injections for the treatment of lateral epicondylitis initially relieve patients' symptoms significantly more than physical therapy or no treatment, 1-year outcomes are actually worse than for either of the two alternative strategies, Dutch investigators report in The Lancet for February 23.

Dr. Nynke Smidt, of the VU University Medical Centre in Amsterdam, and colleagues randomly assigned patients with symptoms of lateral epicondylitis lasting at least 6 weeks to one of the three treatments.

The 60 patients assigned to triamcinoloneacetonide and lidocaine received up to three injections during the 6-week intervention period. Sixty-four patients receive physiotherapy that included pulsed ultrasound, deep friction massage, and an exercise program for up to eight 30-minute sessions. The remaining 59 subjects visited their physician once for advice.

The main outcome measures included self-assessment of general improvement, severity of main complaint, pain and inconvenience during the day, elbow disability and pain-free grip strength.

"At 6 weeks, significant differences in favor of corticosteroid injections were seen for all primary and secondary outcomes," the investigators write. "By contrast, at 26 and 52 weeks, significant differences for nearly all outcome measures were noted in favor of physiotherapy compared with injections."

The percentage of patients who received injections and rated themselves "completely recovered" or "much improved" declined from 92% at 6 weeks to 69% at 52 weeks. For physical therapy, a rate of significant improvement was seen between the two time-points, 47% versus 91%. A wait-and-see policy was not far behind at 32% and 83%, respectively.

The investigators advise that patients be informed about the risks and benefits associated with the different treatment options. "We have no reason to believe that awaiting spontaneous recovery will not be adequate treatment for patients with a short duration of symptoms at presentation," Dr. Smidt's group writes.

Lancet 2002;359:657-662.

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