Lateral Epicondylitis: Review of Injection Therapies

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Key points

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    There are several described injection therapies for lateral epicondylitis, but no 1 treatment has been agreed upon. There is a scarcity of large, blinded, uniformly designed randomized trials.

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    Botulinum toxin, autologous blood, platelet-rich plasma, hyaluronic acid, and prolotherapy injections have all demonstrated benefit over placebo in studies of varied size and quality.

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    Glucocorticoid injections are effective at reducing pain in the short-term; however, they are no different than placebo

Treatment

There have been numerous described methods for therapy. Unfortunately, there has been no single agreed-upon treatment for lateral epicondylitis. The most conservative treatment is observational, or a wait-and-see approach. Most patients will report improvement of symptoms by 1 year after initial onset.9 Activity modification and nonsteroidal anti-inflammatory drugs (NSAIDs) have been described for symptomatic pain relief. Other conservative treatments include various types of physiotherapy,

Glucocorticoids

Glucocorticoid injections have a long history in the treatment of lateral epicondylitis, with descriptions of their use as early as the 1950s.10 Originally, when lateral epicondylitis was believed to be an inflammatory process, steroid injections were thought to act as a local anti-inflammatory modality. However, as the understanding of the pathology of lateral epicondylitis has evolved, so have the explanations for the beneficial effects of steroid injections. Although there are few

Hyaluronic Acid

Hyaluronic acid is a high-molecular weight glycosaminoglycan found in diverse tissues throughout the body, including within connective tissue. It has been noted to function as an induction agent for early inflammation, as well as an inflammatory mediator.37, 38 Hyaluronic acid has been utilized as an intra-articular viscosupplementation agent for osteoarthritis, and has been proven to be relatively safe in this application. Its use was expanded to include soft tissues when Petrella and

Injection technique

Injection of the lateral epicondyle can be performed in a number of different ways, and no 1 method is agreed upon in the literature. Nonetheless, basic guidelines can be followed. Informed consent should be obtained prior to any injection. Risks of the injection should include risks specific to the injected substance, as well as pain and infection. Sterile technique should be practiced. The location and exact technique for injection may vary between practitioners.

The injection location has

Summary

Lateral epicondylitis is a common musculoskeletal ailment affecting adults, and there is no definitively agreed upon therapy with consistent results. It is thought to be self-limited, but it often takes extended time to resolve. As with the majority of orthopedic conditions, the first line in the treatment algorithm includes conservative therapies, comprised of activity modification and physiotherapy with braces, exercise, and ultrasound. However, a prolonged symptomatic course is not uncommon

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    Disclosures: Salary from Journal of Hand Surgery, Elsevier Inc (J.M. Wolf).

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