This article is more than 5 years old. Information may no longer be current.
No significant differences seen with steroids vs. placebo for lateral elbow pain
Groups showed similar grip strength, pain and DASH scores at both 1- and 6-month follow-ups.
SAN FRANCISCO — Investigators found no benefit of corticosteroid injection compared to placebo injection for the treatment of lateral elbow pain and that depression and ineffective coping skills are the strongest predictors of perceived disability.
In a randomized, double-blind placebo controlled study, Marjolijn Henket and colleagues compared the results of 64 patients who received either dexamethasone or placebo injection for lateral elbow pain. Patient demographics, grip strength, pain and DASH scores showed no significant differences between the groups at enrollment or at 1- and 6- month follow-up.
Pain and depression
She said that after performing a multivariate analysis, the investigators found that patients who scored high on the depression scale and low on coping skills for pain also had high disability and pain scores at 1- and 6- months follow-up. Her comments came during the American Academy of Orthopedic Surgeons 75th Annual Meeting.
The study included patients who received treatment for lateral elbow pain who were symptomatic for less than 6 months and excluded those who had prior injection or previous surgery on their arm. The investigators randomized patients to receive one injection of either dexamethasone and 1% lidocaine, or 1% lidocaine alone.
“Both the surgeon and the patient were blinded to treatment allocation,” David C. Ring, MD, PhD, the study’s lead author told Orthopedics Today. “Consistent with ethical research principles, patient autonomy was respected, but only six patients requested a second injection.”
At enrollment, the investigators determined patients’ disability using the DASH score, measured their grip strength and evaluated pain on the Visual Analog Scale. They also assessed patients using four psychological questionnaires.
“Each group had less pain at their follow-up than when they were enrolled,” Henket said.
A multivariate analysis revealed that DASH scores strongly correlated with depression and poor coping skills (P<.001), the investigators wrote in their abstract.
“According to the best available scientific evidence — including more than 50 randomized trials among which are three comparable placebo-injection controlled trials of corticosteroid injection — lateral
epicondylitis is a self-limited enthesopathy of middle age and none of our treatments have established efficacy in shortening the approximately year-long duration of the illness,” Ring said in summing up the study findings. “Activity levels add pain intensity are affected most strongly by mood, adaptability and resilience. This is basically common sense: The healthier one feels, the less such conditions bother us. Under stress we suffer more.”
For more information:
- Marjolijn Henket, is a research fellow in upper extremity at Massachusetts General Hospital, Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114; 617-724-3953.
- David C. Ring, MD, PhD, can also be reached at Massachusetts General Hospital, Orthopaedic Hand and Upper Extremity Service; e-mail: dring@partners.org.
Reference:
- Henket M, Lindenhovius AL, Lozano-Calderon SA, et al. Corticosteroid injection for lateral elbow pain: A randomized double blind placebo controlled trial. Paper #241. Presented at 75th Annual Meeting of the American Academy of Orthopedic Surgeons. March 5-9, 2008. San Francisco.