Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care

Staffordshire Rheumatology Centre, The Haywood, Burslem, Stoke on Trent ST6 7AG.
BMJ Clinical Research (Impact Factor: 14.09). 11/1999; 319(7215):964-8. DOI: 10.1136/bmj.319.7215.964
Source: PubMed


To compare the clinical effectiveness of local corticosteroid injection, standard non-steroidal anti-inflammatory drugs, and simple analgesics for the early treatment of lateral epicondylitis in primary care.
Multicentre pragmatic randomised controlled trial.
23 general practices in North Staffordshire and South Cheshire.
164 patients aged 18-70 years presenting with a new episode of lateral epicondylitis. Interventions: Local injection of 20 mg methylprednisolone plus lignocaine, naproxen 500 mg twice daily for two weeks, or placebo tablets. All participants received a standard advice sheet and co-codamol as required.
Participants' global assessment of improvement (five point scale) at four weeks. Pain, function, and "main complaint" measured on 10 point Likert scales at 4 weeks, 6 months, and 12 months.
Over 2 years, 53 subjects were randomised to injection, 53 to naproxen, and 58 to placebo. Prognostic variables were similar between groups at baseline. At 4 weeks, 48 patients (92%) in the injection group were completely better or improved compared with 30 (57%) in the naproxen group (P<0.001) and 28 (50%) in the placebo group (P<0.001). At 12 months, 43 patients (84%) in the injection group had pain scores </=3 compared with 45 (85%) in the naproxen group and 44 (82%) in the placebo group (P>0.05).
Early local corticosteroid injection is effective for lateral epicondylitis. Outcome at one year was good in all groups, and effective early treatment does not seem to influence this.

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Available from: Martyn Lewis, Sep 15, 2015
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    • "While the underlying pathology of lateral epicondylitis at the end stage is not inflammatory, the use of nonsteroidal anti-inflammatory drugs (NSAID) may be a useful adjunct to activity modification.7 There is a lack of data to support their oral use.42,54 In contrast, Brunham et al7 noted short-term relief associated with a topical NSAID in their randomized double-blind crossover study. "
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    09/2012; 4(5):384-93. DOI:10.1177/1941738112454651
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    • "In our study group B showed a statistically significant decrease in VAS score and Nirschl stage at one and four weeks compared with group A. Hay et al30 found similar results when local corticosteroid injection was compared with oral naproxen. "
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    08/2012; 1(8):192-7. DOI:10.1302/2046-3758.18.2000095
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    • "It has been claimed that conservative care leads to recovery in up to 90% of TE patients within 1–2 years and that surgery is indicated in less than 10% of the cases [5, 6, 25]. However, recent studies of patients with elbow complaints, including TE, in general practice report a less favourable prognosis [2, 17]. Bot and co-workers found that although 90% of all patients reported at least some improvement after 1 year of follow-up, only 13% of the patients reported full recovery at the 3-month follow-up and 34% at 12 months [2]. "
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