Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Effect of Corticosteroid Injection with and Without Dry Needling on Pain Intensity in Patients with Tennis Elbow: A Randomized Clinical Trial Study

Document Type : Original Article (s)

Authors
Mohammad Hossein Besharati 1
Seyed Hossein Saeed Banadaky 2
Abbas Abdoli Tafti 2
Sara Jam Barsang 3
1 Orthopedic Student, Department of Orthopedic Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Assistant Professor, Department of Statistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
10.48305/jims.v40.i666.0202
Abstract
Background: Tennis elbow is a condition in which pain is felt in the lateral part of the elbow due to the excessive extension of the wrist. This study aimed to compare the local injection effect of the corticosteroid alone vs corticosteroid alongside dry needling, in easing pain intensity.
Methods: In this randomized clinical trial, 90 patients (45 cases group and 45 controls group) with tennis elbow were investigated. In the case and control groups, local corticosteroid injection was done alongside dry needling (continuous movement of the needle to injure the bony cortex at the origin of the extensor carpal radialis brevis muscle) and without needling, respectively. Finally, changes in pain severity before, three, and six months after treatment were compared between the two groups using a visual analog scale.
Findings: The mean age of patients in the case and control groups was 45.17 ± 7.93 and 46.62 ± 6.23, respectively while the observed difference was not statistically significant. Comparison of pain intensity between two groups showed that the pain intensity score in the case group was significantly lower than the control group even after adjusting for age and gender. In the study groups, pain intensity score changes were not statistically significant during different time intervals.
Conclusion: Based on the results, injection of corticosteroids alongside dry needling can be more effective compared to the injection of corticosteroids without dry needling in reducing pain intensity.
Keywords
Corticosteroid
Drug therapy
Tennis elbow
Pain management
Needles
  1. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333(7575): 939.
  2. Lin YC, Tu YK, Chen SS, Lin IL, Chen SC, Guo HR. Comparison between botulinum toxin and corticosteroid injection in the treatment of acute and subacute tennis elbow: a prospective, randomized, double-blind, active drug-controlled pilot study. Am J Phys Med Rehabil 2010; 89(8): 653-9.
  3. Judson CH, Wolf JM. Lateral epicondylitis: review of injection therapies. Orthop Clin North Am 2013; 44(4): 615-23.
  4. Toker S, Kilinçoğlu V, Aksakalli E, Gülcan E, Ozkan K. [Short-term results of treatment of tennis elbow with anti-inflammatory drugs alone or in combination with local injection of a corticosteroid and anesthetic mixture]. Acta Orthop Traumatol Turc 2008; 42(3): 184-7. [In Turkish].
  5. Chilton SA. Tennis elbow: a combined approach using acupuncture and local corticosteroid injection. Acupuncture in Medicine 1997; 15(2): 77-8.
  6. Verhaar JA, Walenkamp GH, van Mameren H, Kester AD, van der Linden AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg Br 1996; 78(1): 128-32.
  7. Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol 2008; 27(8): 1015-9.
  8. Sukumar S, Lawrence M, Subhashchandra R. Early effects of dry needling and low level laser therapy in chronic tennis elbow- an experimental study. Int J
    Health Sci Res 2015; 5(1): 187-96.
  9. McShane JM, Shah VN, Nazarian LN. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary? J Ultrasound Med 2008; 27(8): 1137-44.
  10. Lekkreusuwan K, Toraudom Y. Comparison between Percutaneous Needle Release and Local Corticosteroid Injection for the Treatment of Tennis Elbow. The Thai Journal of Orthopaedic Surgery 2014; 38(1-2): 9-15.
  11. Altay T, Gunal I, Ozturk H. Local injection treatment for lateral epicondylitis. Clinical orthopaedics and related research. 2002(398):127-30.
  12. Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 2002; 359(9307): 657-62.
  13. Saccomanni B. Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature. Curr Rev Musculoskelet Med 2010; 3(1-4): 38-40.
  14. Hsieh LF, Kuo YC, Lee CC, Liu YF, Liu YC, Huang V. Comparison between corticosteroid and lidocaine injection in the treatment of tennis elbow: a randomized, double-blinded, controlled trial. Am J Phys Med Rehabil 2018; 97(2): 83-9.
  15. Gulabi D, Uysal MA, Akça A, Colak I, Çeçen GS, Gumustas S. USG-guided injection of corticosteroid for lateral epicondylitis does not improve clinical outcomes: a prospective randomised study. Arch Orthop Trauma Surg 2017; 137(5): 601-6.
Journal of Isfahan Medical School
Volume 40, Issue 666
2nd Week, June
May and June 2022
Pages 202-208

  • Receive Date 16 October 2021
  • Revise Date 13 June 2022
  • Accept Date 29 May 2022