title: Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Lateral epicondylitis is a common painful elbow disorder. Several approaches to treatment have been proposed, with a local injection of corticosteroids being the most frequently used. Recent insights into the pathophysiology encouraged the introduction of autologous blood injections as an alternative treatment method. The aim of this meta-analysis is to summarize quantitatively the evidence regarding the efficacy of corticosteroids and autologous blood injections for treatment of pain in lateral epicondylitis.
  
  
  METHODS
  Studies were considered eligible based on the following inclusion criteria: adult human, diagnosis of lateral epicondylitis, randomized controlled trials comparing corticosteroids versus autologous blood injections, pain assessment. Exclusion criteria were previous surgery for lateral epicondylitis or for other elbow disorders, concurrent treatment with drugs or physiotherapy, diagnosis of musculoskeletal systemic disorder. A systematic search of literature was performed according to the PRISMA statement. Effect size of each included study was calculated and analyzed in a random-effects model.
  
  
  RESULTS
  Four studies, enrolling total of 218 patients (139 females and 79 males), were included in quantitative analysis. At 2 weeks, there was a trend towards a reduction of VAS score in the corticosteroid group (WMD=2.12 [95% CI: 4.38 to 0.14], P=0.07). No significant differences were recorded in the medium-term (4-12 weeks; WMD=0.85 [95% CI: -0.44 to 2.15], P=0.19) and long-term (24 weeks; WMD=0.63 [95% CI: -2.40 to 3.66], P=0.68) follow-up.
  
  
  CONCLUSIONS
  Few high-quality trials compare the efficacy of corticosteroid and autologous blood injections in the control of pain related to lateral epicondylitis. Available data indicate that corticosteroids tend to reduce VAS score in short-term follow-up, although these data are not statistically significant. No differences were recorded in the medium and long term. Contrary to popular opinion among medical professionals, and despite pathophysiological cues, the currently available data offer no support for the effectiveness of autologous blood injections in medium- and long-term follow-up. Further studies are necessary to establish which treatment has more impact on pain in lateral epicondylitis. These data could be then used as a basis for practical guidelines and new protocols of treatment.
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy - sirico.felice@gmail.com.
authors: Felice
authors: F
authors: Sirico
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy.
authors: Flavia
authors: F
authors: Ricca
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy.
authors: Franca
authors: F
authors: DI Meglio
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy.
authors: Daria
authors: D
authors: Nurzynska
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy.
authors: Clotilde
authors: C
authors: Castaldo
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy.
authors: Rocco
authors: R
authors: Spera
authors: Sports Medicine Division, Department of Public Health, Federico II University, Naples, Italy.
authors: Stefania
authors: S
authors: Montagnani
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001804:Blood Transfusion, Autologous; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013716:Tennis Elbow / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones