title: Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial.
abstract: OBJECTIVE
  We aimed to compare the efficacy of two different injection techniques of local corticosteroid and local anesthetic in the management of lateral epicondylitis.
  
  
  METHODS
  This prospective study followed 80 consecutive patients who were diagnosed with lateral epicondylitis at our hospital outpatient clinic between 2005 and 2006. Patients were randomly assigned into two equal groups. Group 1 received a single injection of 1 ml betamethasone and 1 ml prilocaine on the lateral epicondyle at the point of maximum tenderness. Group 2 patients received an injection of the same drug mixture. Following the initial injection, the needle tip was redirected and reinserted down the bone approximately 30 to 40 times without emerging from the skin, creating a hematoma. Patients were evaluated with the Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire before injection and at the final follow-up. The unpaired t-test and chi-square tests were used to compare results.
  
  
  RESULTS
  Sixteen patients in Group 1 and 15 patients in Group 2 were lost during follow-up. The average follow-up period of the remaining 49 patients was 21.6 months. There were no significant differences between the two groups with regard to gender, age, follow-up period, symptom duration, involvement side and number of dominant limbs. The Turkish DASH scores of Group 2 were significantly lower than those of Group 1 (p=0.017).
  
  
  CONCLUSIONS
  Long-term clinical success in the treatment of lateral epicondylitis depends on the injection method. The peppering technique appears to be more effective than the single injection technique in the long-term.
authors.affiliation: Department of Orthopedics and Traumatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey. ggokcu@hotmail.com
authors.forename: Güvenir
authors.initials: G
authors.lastname: Okçu
authors.forename: Serkan
authors.initials: S
authors.lastname: Erkan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sentürk
authors.forename: R Taçkın
authors.initials: RT
authors.lastname: Ozalp
authors.forename: H Serhat
authors.initials: HS
authors.lastname: Yercan
mesh_terms: D000465:Algorithms; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010147:Pain Measurement; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013716:Tennis Elbow / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D011318:Prilocaine; D001623:Betamethasone