title: Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial.
abstract: BACKGROUND
  To determine the effectiveness of three different local injection modalities in the treatment of lateral epicondilitis.
  
  
  METHODS
  In a prospective randomized study on lateral epicondilitis, 75 patients were divided into three equal groups A, B and C (n = 25) and were treated using three different method of local injection. The patients in group A were treated with local injection of a steroid (1 mL triamcinolone) combined with local anaesthetic (1 mL lidocaine), those in group B were treated with injection of local anaesthetic (1 mL lidocaine) combined with peppering technique and those in group C with local injection of a steroid (1 mL triamcinolone) combined with local anaesthetic (1 mL lidocaine) and peppering technique. The outcome was defined by measuring the elbow pain during the activity using a 10-cm visual analogue scale (VAS) and satisfaction with the treatment using a scoring system based on the criteria of the Verhaar et al. at 3 weeks and 6 months after the injection and compared with the pre-treatment condition.
  
  
  RESULTS
  There were significant (P = 0.006) differences in the successful outcomes between the three groups at 6 months. In group C in which local steroid + peppering injection technique were used; excellent results were obtained in 84% of patients comparing to 36% and 48% for patients in groups A and B, respectively. The successful outcomes were statistically higher in group C comparing to group A (P = 0.002) and group B (P = 0.011). In all groups, there was a significantly lower pain (VAS) at the 3-week and 6-month follow-ups comparing to the pre-treatment condition. VAS measured at 6-month follow-up were significantly lower in group C comparing to other groups (P = 0.002).
  
  
  CONCLUSIONS
  In the treatment of lateral epicondilitis, combination of corticosteroid injections with peppering is more effective than corticosteroid injections or peppering injections alone and produces better clinical results.
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Mustafa Kemal University, 31100 Antakya, Hatay, Turkey. yunus_latif@yahoo.com
authors.forename: Yunus
authors.initials: Y
authors.lastname: Dogramaci
authors.forename: Aydiner
authors.initials: A
authors.lastname: Kalaci
authors.forename: Nazan
authors.initials: N
authors.lastname: Savaş
authors.forename: I Gokhan
authors.initials: IG
authors.lastname: Duman
authors.forename: A Nedim
authors.initials: AN
authors.lastname: Yanat
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013716:Tennis Elbow / Q000188:drug therapy*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D014221:Triamcinolone; D008012:Lidocaine