Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ.333:939

School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia 4072.
BMJ (online) (Impact Factor: 17.45). 12/2006; 333(7575):939. DOI: 10.1136/bmj.38961.584653.AE
Source: PubMed
To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.
Single blind randomised controlled trial.
Community setting, Brisbane, Australia.
198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.
Eight sessions of physiotherapy; corticosteroid injections; or wait and see.
Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.
Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.
Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.
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    • "[2] fizyoterapinin 6. haftadan sonra kortikosteroid enjeksiyonuna kıyasla daha olumlu sonuçlar sağladığını ancak bekle-gör yöntemine üstün olmadığını belirtmişlerdir. [2] Bir diğer çalışmada düşük seviyeli lazer terapinin lateral epikondilit tedavisinde uygun dozda kullanıldığında etkili olduğu belirtilmiştir. [38] Bununla beraber ağrının egzersiz verilen hastalarda, egzersiz tedavisi almayanlara kıyasla daha fazla azaldığı, [6] gözetimli egzersiz programlarının cyriax FT'ye kıyasla daha etkili olduğu belirtilmiştir. "
    Preview · Article · Mar 2016
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    • "A study comparing the effectiveness of physical therapy and CS injections, reported that CSs are superior in the short-term but physical therapy is superior in the long-term. [15,16] With regard to tennis elbow, Tonks et al. [17] assessed the relative merits of a 'watch and wait' policy, physiotherapy alone, steroid injection therapy alone, and combined physiotherapy and steroid injection therapy, using a prospective randomized controlled trial design. After 7 weeks, patients who received steroid injections had significantly superior outcomes on all measures at follow-up. "
    Preview · Article · Jan 2016
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    • "Recent years have seen a growing interest in exercise as treatment for chronic tendinopathies [10, 28] . A few recent studies have reported a clear tendency in favor of exercise as compared with expectation [26,28]. Likewise, a study done in 81 subjects with TE concluded that chronic TE should not be treated with rest but with graded exercise [26]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background. Lateral epicondylitis, or tennis elbow, is a common overuse syndrome of the extensor tendons of the forearm. When the condition is chronic or not responding to initial treatment, physical therapy is initiated. The objective of this study is to compare the effectiveness of corticosteroid injections with physiotherapeutic interventions (ultrasound and exercise) for the treatment of chronic lateral epicondylitis. Material and methods. We performed a randomized controlled trial of 12 weeks’ duration in patients with chronic lateral epicondylitis. We randomly assigned 49 subjects to an exercise group (n=25), who received ultrasound and exercise, and a control group (n=24), who were treated with local infiltration of 1mL triamcinolone acetonide (10mg/mL) and 1mL lidocaine 2%. To evaluate the subjects, three instruments were used: pain intensity, measured with a Visual Analogue Scale (VAS), functional disability, measured with the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, and painfree grip strength. All subjects were evaluated before treatment and at the 6th and 12th week. Results. There were no significant differences between the two groups with regard to any variable at baseline (p>0.05). In the exercise group, significant improvements were demonstrated for VAS, PRTEE pain score, PRTEE function score and pain free grip strength, compared to the control group. The exercise group reported a significantly greater increase in all variables at 12 weeks than did the control group (p<0.001). Conclusion. Our results suggest that ultrasound therapy and exercise are beneficial in the treatment of tennis elbow.
    Full-text · Article · Sep 2015 · Ortopedia, traumatologia, rehabilitacja
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