title: Comparison of the effects of sodium hyaluronate-chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: a prospective randomized trial.
abstract: BACKGROUND
  Hyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA + CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis.
  
  
  METHODS
  In total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA + CS group, 25 patients received a single injection of a solution containing an HA + CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6 months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated.
  
  
  RESULTS
  No serious adverse events were reported throughout the study. The mean pain and function scores for the HA + CS and triamcinolone groups had significantly improved at 3 months, but the mean function scores in the HA + CS group were statistically significantly better when compared to the triamcinolone group. At 6 months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA + CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA + CS group was much better when compared with the triamcinolone group, and the HA + CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6 months.
  
  
  CONCLUSIONS
  This study supports the idea that for a single injection treatment of patients with lateral epicondylitis, a combination injection of HA + CS may offer better pain benefits for 6 months after injection, when compared to triamcinolone.
  
  
  METHODS
  Level II, Randomized Clinical Trial, Prospective Comparative Study.
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey. bayramtosun@hotmail.com.
authors.forename: Haci Bayram
authors.initials: HB
authors.lastname: Tosun
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey.
authors.forename: Seyitali
authors.initials: S
authors.lastname: Gumustas
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Agir
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey.
authors.forename: Abuzer
authors.initials: A
authors.lastname: Uludag
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey.
authors.forename: Sancar
authors.initials: S
authors.lastname: Serbest
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey.
authors.forename: Demet
authors.initials: D
authors.lastname: Pepele
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Inonu University, Malatya, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Ertem
mesh_terms: D002809:Chondroitin Sulfates / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008875:Middle Aged; D011446:Prospective Studies; D013716:Tennis Elbow / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
chemical_list: D004338:Drug Combinations; D005938:Glucocorticoids; C501944:chondroitin sulfate, sodium hyaluronate drug combination; D014221:Triamcinolone; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates