Physiotherapy, steroid injections, or rest for lateral epicondylosis? What the evidence suggests.
OBJECTIVE
To identify effective lateral epicondylosis interventions and assess the quality of research over time.


METHODS
Relevant MEDLINE and EMBASE searches respectively yielded 226 and 187 potential studies. Additional citations were extracted from bibliographies. Thirty controlled trials met inclusion criteria. The Cochrane Collaboration guidelines "quality score" served to rate studies.


RESULTS
In the short term (<2 to 3 months) steroid injections and physiotherapy outperformed relative rest. Physiotherapy appears efficacious regardless of time frame. After 3 months, active physiotherapy outperforms injections, but does not appear significantly better than rest. Evidence was neutral or insufficient regarding ultrasound, splinting, or manipulation. Nonsignificant correlations between publication year and study quality score were found.


CONCLUSIONS
Overall research quality has not improved with time. Steroid injections appear the most successful short-term intervention for pain relief. Active physiotherapy appears efficacious regardless of time frame.
Nimgade
Ashok
A
Harvard School of Public Health, Occupational Health Program, Cambirdge Health Alliance, Cambridge, Massachusetts, USA. animgade@hms.harvard.edu
Sullivan
Meaghan
M
Goldman
Rose
R