From the Guidelines
Corticosteroid injections are the most effective type of injection for lateral epicondylitis in the acute phase, despite their potential to weaken tendon structure with repeated use. The use of corticosteroid injections for lateral epicondylitis is supported by studies, which show that they are more effective than NSAIDs in the acute phase of epicondylosis, although they do not change long-term outcomes of pain 1.
Some key points to consider when using corticosteroid injections for lateral epicondylitis include:
- The optimal drugs, dosages, techniques, intervals, and post-injection care remain unknown 2
- Injected corticosteroids may be more effective than oral NSAIDs for relief in the acute phase of tendon pain, but they do not tend to alter long-term outcomes 2
- There may be deleterious effects on the tendon when corticosteroids are injected into the tendon substance 2
- The effects of peritendinous corticosteroid injections are unknown, but they should be used with some caution 2
Alternative injection options, such as platelet-rich plasma (PRP) and botulinum toxin, may also be considered, although their effectiveness varies among patients. Proper technique involves identifying the point of maximum tenderness, using a 25-27 gauge needle, and injecting into the area where the extensor carpi radialis brevis attaches to the lateral epicondyle. Post-injection, patients should rest the arm for 24-48 hours and gradually return to activities as tolerated.
From the FDA Drug Label
Epicondylitis may be treated by infiltrating the preparation into the area of greatest tenderness. The type of injection for lateral epicondylitis is an infiltration of the preparation into the area of greatest tenderness, as stated in the drug label 3.
- Key points: + Infiltration is the recommended method of injection. + The preparation should be injected into the area of greatest tenderness.
From the Research
Types of Injections for Lateral Epicondylitis
- Platelet-rich plasma (PRP) injections: Studies have shown that PRP injections do not improve pain or function at 1 year of follow-up in people with lateral epicondylitis compared with those who were given a saline injection 4. However, other studies suggest that PRP injections can be effective in the long term, with improvements in pain intensity and function 5, 6.
- Autologous blood injections: Autologous blood injections did not improve disability ratings compared to saline injections 7. However, some studies suggest that autologous blood products, including autologous blood, can significantly improve pain and elbow function in the intermediate term 8.
- Corticosteroid injections: Corticosteroid injections can effectively relieve pain and improve elbow function in the short term, but their effectiveness in the long term is unclear 8, 5.
- Other injections: Botulinum toxin injections can modestly improve pain in lateral epicondylitis, but with short-term grip-strength weakness 7. Prolotherapy injections and hyaluronic acid injections have also been studied, but their effectiveness is less clear 7.
Comparison of Injections
- A systematic review and meta-analysis found that corticosteroid injections ranked first for visual analog score, modified Nirschl score, maximum grip strength, modified Mayo score, and Patient-Related Tennis Elbow Evaluation score for the short-term period, while PRP ranked first for these outcomes in the long-term period 5.
- Another study found that both leukocyte-rich PRP and leukocyte-poor PRP were effective in achieving minimal clinically important difference in patient-reported outcome measures 6.
Effectiveness of Injections
- The effectiveness of PRP injections in lateral epicondylitis treatment remains debatable, but some studies suggest that they can be effective in achieving minimal clinically important difference in patient-reported outcome measures 6.
- Autologous blood injections and corticosteroid injections have also been shown to be effective in some studies, but their effectiveness can vary depending on the study and the outcome measures used 8, 7, 5.