Mobilisation with movement and exercise, corticosteroid injection and wait and see for tennis elbow: randomised trial

Bisset, Leanne, Beller, Elaine, Jull, Gwendolen, Brooks, Peter, Darnell, Ross and Vicenzino, Bill (2006) Mobilisation with movement and exercise, corticosteroid injection and wait and see for tennis elbow: randomised trial. BMJ, 333 7575: 939-944. doi:10.1136/bmj.38961.584653.AE

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Author Bisset, Leanne
Beller, Elaine
Jull, Gwendolen
Brooks, Peter
Darnell, Ross
Vicenzino, Bill
Title Mobilisation with movement and exercise, corticosteroid injection and wait and see for tennis elbow: randomised trial
Journal name BMJ
ISSN 0959-535X
1756-1833
0959-8138
Publication date 2006-11-04
Year available 2006
Sub-type Article (original research)
DOI 10.1136/bmj.38961.584653.AE
Open Access Status DOI
Volume 333
Issue 7575
Start page 939
End page 944
Total pages 6
Editor Trevor Jackson
Fiona Godlee
Place of publication London, U.K.
Publisher BMJ Publishing Group
Language eng
Formatted abstract
Objective
To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.

Design

Single blind randomised controlled trial.

Setting

Community setting, Brisbane, Australia.

Participants

198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.

Interventions

Eight sessions of physiotherapy; corticosteroid injections; or wait and see.

Main outcome measures

Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.

Results

Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was Superior to wait and see in the short term: no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy Sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.

Conclusion

Physiotherapy combining elbow manipulation and exercise has a Superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in die management of tennis elbow.
Keyword Medicine, general and internal
Lateral epicondylitis
Grip strength
Upper-limb
Musculoskeletal disorders
Primary-care
Physiotherapy
Prevalence
Pain
Interventions
Complaints
Q-Index Code C1

 
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Created: Wed, 02 Jan 2008, 09:24:53 EST by Thelma Whitbourne on behalf of School of Public Health