THE COMPARISON OF SINGLE DOSE VERSUS MULTI-DOSE LOCAL CORTICOSTEROID INJECTIONS FOR TENNIS ELBOW

Abstract

Purpose: To study the efficacy of single dose versus multi-dose local corticosteroid injections for tennis elbow in a prospective, randomized, clinical trial of fifty-two elbows. Material and
Methods: Fifty-two patients (fiftytwo elbows) were assigned randomly into two groups. We injected single dose of 0,5 ml of Betamethasone diluted with 0,5 ml of Prilocaine into the tendinious origin of the extensor carpi radialis brevis and extensor digitorum muscles in twenty-two elbows (Group 1). Thirty elbows received the same dose of local injection after the diagnosis and during the follow-up for an average of 4,2 times (Group 2). Two groups were compared according to the physical examination, intensity of pain, subjective loss of grip strength and graded objectively according to the criteria of Verhaar scoring system.
Results: Six weeks and twelve weeks after the injection, the two groups did not show any difference significantly with regard to pain intensity, subjective satisfaction and according to the Verhaar scoring system. Both groups had significantly less pain than before the treatment (p<0,01). At eighteen months, group 2 showed a significant increase of the pain intensity and worsening of the Verhaar scoring system. No elbow was operated in the first group, but eight elbows were operated (%26,3) in the second because of the failure of conservative treatment.
Discussion: Conservative management of tennis elbow consists of different modalities such as administration of non-steroidal anti-inflammatory medications, local corticosteroid injections, physical therapy, tennis elbow bands and straps, activity modification and extracorporal shock wave therapy. The choice of treatment for tennis elbow remains controversial because it lacks any scientific basis and evidence in the literature. Most of the clinical trials those investigate the efficacy of local corticosteroid injections noted temporary relief of pain and significant improvement in the short term period but recurrences were common during long term period. In the current study, we found significantly worse results in the long term follow-up who got multidose local injections. This might be due to the accumulation of the deleterious effects of corticosteroids on the tendon tissue and thereby might compromise healing. One should take this point into account when performing multi-dose corticosteroid injections based on the personal experience only for the treatment of tennis elbow.