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General Practice

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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Trial pragmatic but not accurate?

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

01 November 1999
Manjit Bhamra
Consultant Orthopaedic & Trauma Surgeon
Rotherham general Hospital