title: Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review.
abstract: OBJECTIVE
  To evaluate the current evidence for the efficacy of corticosteroid injection and non-electrotherapeutic physiotherapy compared with control for treating lateral epicondylitis.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We searched five databases in September 2012 for randomised controlled studies with a minimum quality rating. Of the 640 studies retrieved, 11 were included, representing 1161 patients of both sexes and all ages.
  
  
  METHODS
  Corticosteroid injection and non-electrotherapeutic physiotherapy.
  
  
  METHODS
  Relative risk (RR) or standardised mean difference (SMD) for overall improvement, pain and grip strength at 4-12, 26 and 52 weeks of follow-up.
  
  
  RESULTS
  Corticosteroid injection gave a short-term reduction in pain versus no intervention or non-steroidal anti-inflammatory drugs (SMD -1.43, 95% CI -1.64 to -1.23). At intermediate follow-up, we found an increase in pain (SMD 0.32, 95% CI 0.13 to 0.51), reduction in grip strength (SMD -0.48, 95% CI -0.73 to -0.24) and negative effect on the overall improvement effect (RR 0.66 (0.53 to 0.81)). For corticosteroid injection versus lidocaine injection, the evidence was conflicting. At long-term follow-up, there was no difference on overall improvement and grip strength, with conflicting evidence for pain. Manipulation and exercise versus no intervention showed beneficial effect at short-term follow-up (overall improvement RR 2.75, 95% CI 1.30 to 5.82), but no significant difference at intermediate or long-term follow-up. We found moderate evidence for short-term and long-term effects of eccentric exercise and stretching versus no intervention. For exercise versus no intervention and eccentric or concentric exercise and stretching versus stretching alone, we found moderate evidence of no short-term effect.
  
  
  CONCLUSIONS
  Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. Evidence on the long-term effect is conflicting. Manipulation and exercise and exercise and stretching have a short-term effect, with the latter also having a long-term effect.
authors.affiliation: Department of General Practice, University of Oslo, Oslo, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Olaussen
authors.forename: Oeystein
authors.initials: O
authors.lastname: Holmedal
authors.forename: Morten
authors.initials: M
authors.lastname: Lindbaek
authors.forename: Soeren
authors.initials: S
authors.lastname: Brage
authors.forename: Hiroko
authors.initials: H
authors.lastname: Solvang
keywords: SPORTS MEDICINE