Injection of methylprednisolone and lidocaine in the treatment of medial epicondylitis:a randomized clinical trial

摘要

Conservative treatment of medial epicondylitis including splinting, physical therapy, nonsteroidal antiinflammatory drugs (NSAIDs), and local injection of steroids has been reported to be successful in most reported cases. In the present study, we evaluated the effectiveness of local injection of steroids. Over a period of 5 years (1997 - 2001), we randomized 38 patients (40 elbows) seen in our private clinics into two groups. The treatment group (20 elbows) received one injection of 40 mg methylprednisolone and 1% lidocaine, and the control group (20 elbows) received one injection of normal saline and 1% lidocaine. Patients in both groups were given standard NSAIDs, physical therapy, and splinting. Pain severity was assessed at 2, 4, and 12 months. The severity of pain in both groups was same before the treatment and there was no significant difference between the two groups. The difference in pain score between the two groups at 2 months was statistically significant (p = 0.01). At 4 months, the mean pain scores in the two groups were similar (p = 0.673) and there were no significant differences between the two groups at 12 months (p = 0.942, Mann-Witney test).Since local injection of a steroid had only short-term benefits, we do not recommend it for the treatment of medial epicondylitis. NSAIDs, splinting, and physical therapy provide the best conservative approach in this condition; steroid injection near a sensitive nerve (ulnar nerve) is not justified.