Comparative Results of Non-surgical Long Term Treatments of Tennis Elbow Disease

Background and Objectives: Tennis elbow or lateral epicondylitis disease is caused by overuse of forearm muscle, and tension of carpi radialis brevis tendon. Since there are no accepted criteria for treatment of the disease, this study was conducted with the aim of comparative efficacy of four non-surgical treatment procedures in Shahrekord in ۲۰۰۳. Materials and Methods: This double blind clinical trial investigated the efficacy of four non-surgical procedures in ۱۲۰ patients (۴ groups of ۳۰) with mean age of ۳۷ as follows: ۱) local corticosteroid injection (۲۰ mg of methylprednisolone + lidocaine), ۲) administration of NSAID (۵۰۰ mg of naproxen b.i.d for ۲ weeks), ۳) forearm supportive bands, ۴) physical therapy and progressive exercise. The elbows of all patients were immobilized by cast for two weeks and they were advised to avoid repetitive arm movement for ۲۱ days. The first evaluation was carried out before treatment and the data were recorded. Overall recovery evaluation was conducted in the ۱st, ۳rd, ۶th and ۹th months post – treatment through a ۲۴-score standard and the data were analysed using SPSS version ۱۲ software and paired t test. Results: In the first evaluation the mean calculated score was ۱۹.۰۴ for all groups. In post-treatment period the results were as follows: by the end of the first month the scores for ۴ groups were ۶, ۸, ۱۱ and ۱۲ respectively, by the end of the ۳rd month ۹, ۱۱, ۸ and ۸ respectively by the end of the ۶th month ۹, ۸, ۶ and ۵ respectively and by the end of the ۹th months ۸, ۸, ۵ and ۳ respectively. Differences in mean score were statistically significant except the ۳rd month which showed no significant difference (p=۰.۰۵). Furthermore, final score of the first month showed the highest difference in corticosteroid-treated group with pre-treatment period compared to other groups (p=۰.۰۰۱). By the end of the ۹th month the change in final score in physical therapy group was the highest which showed a significant difference (p=۰.۰۰۵). Conclusion: Local injection of corticosteroid is an effective method to relieve the pain in patients suffering from tennis elbow. However, recurrence of the disease is common during a tree-month period and the results at the end of the ۹th month in physical therapy and exercise group is promising. Thus, the choice non-surgical treatment for the disease is probably the initial corticosteroid injection followed by long term physical therapy.

Keywords:

Lateral epicondylitis , Tennis elbow , Nonsurgical treatment , NSAID , Corticosteroid , Naproxene , Physiotherapy