Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7215.964 (Published 09 October 1999) Cite this as: BMJ 1999;319:964
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Dear Sir
With reference to the above paper, the trial may have been pragmatic
but it DID NOT include all modes of treatment for so called "lateral
epicondylitis", for instance there was not an inclusion of conservative
measures such as physiotherapy and forarm constriction bands.
Also there was no control for the injections that were given and so
the mere act of an invasive injection could have had an effect on the
outcome, eg no placebo injection was given
It has been shown previously (Nirschl, 1993) that there are no
inflammatory cells in the condition of tennis elbow and so it is illogical
to expect either non steriodal antinflammatory drugs or steroid injections
to play a role in the management of this purely traumatic/degenerative
process. Also it calls into doubt the term epicondylitis as inflammatory
cells are absent in this condition on histological examination - a better
non-specific term such as "tennis Elbow" may be better?
Ref
Nirschl, RP Sports and overuse injuries to the elbow. Muscle and
tendon trauma: medial and lateral tennis elbow. In: The Elbow and its
Disorders, 2nd Ed, edited by BF Morrey, Chapter 34. Philadelphia, WB
Saunders, 1993.
Competing interests: No competing interests
EDITOR-Hay et al (1) concluded that corticosteroid injections were
the treatment of choice for lateral epicondylitis. However their study
found that pain in the elbow was significantly increased in the injection
group as compared with both placebo and naproxen groups at the six months
stage. Overall, the area under the pain curve (i.e. total pain
experienced) was 221 in the injection group, compared with 201 in the
naproxen group and 188 in the placebo group. No significance test was
reported for this.
It is clearly too early to suggest that this is the treatment of
choice. Further study of late complications of the injection procedure is
needed to find out why it resulted in increased pain in later follow-up.
1 Hay EM, Paterson SM, Lewis M,Hosie G,Croft P.
Pragmatic randomised controlled trial of local corticosteroid injection
and naproxen for
treatment of lateral epicondylitis of elbow in primary care. BMJ 1999;
319: 964-968
Competing interests: No competing interests
question
greeting
I want to know your scale for evaluation the patients
thanks
Competing interests: No competing interests