Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial

Arch Orthop Trauma Surg. 2009 Oct;129(10):1409-14. doi: 10.1007/s00402-009-0832-x. Epub 2009 Feb 14.


Background: To determine the effectiveness of three different local injection modalities in the treatment of lateral epicondilitis.

Methods: In a prospective randomized study on lateral epicondilitis, 75 patients were divided into three equal groups A, B and C (n = 25) and were treated using three different method of local injection. The patients in group A were treated with local injection of a steroid (1 mL triamcinolone) combined with local anaesthetic (1 mL lidocaine), those in group B were treated with injection of local anaesthetic (1 mL lidocaine) combined with peppering technique and those in group C with local injection of a steroid (1 mL triamcinolone) combined with local anaesthetic (1 mL lidocaine) and peppering technique. The outcome was defined by measuring the elbow pain during the activity using a 10-cm visual analogue scale (VAS) and satisfaction with the treatment using a scoring system based on the criteria of the Verhaar et al. at 3 weeks and 6 months after the injection and compared with the pre-treatment condition.

Results: There were significant (P = 0.006) differences in the successful outcomes between the three groups at 6 months. In group C in which local steroid + peppering injection technique were used; excellent results were obtained in 84% of patients comparing to 36% and 48% for patients in groups A and B, respectively. The successful outcomes were statistically higher in group C comparing to group A (P = 0.002) and group B (P = 0.011). In all groups, there was a significantly lower pain (VAS) at the 3-week and 6-month follow-ups comparing to the pre-treatment condition. VAS measured at 6-month follow-up were significantly lower in group C comparing to other groups (P = 0.002).

Conclusion: In the treatment of lateral epicondilitis, combination of corticosteroid injections with peppering is more effective than corticosteroid injections or peppering injections alone and produces better clinical results.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / therapeutic use
  • Chi-Square Distribution
  • Female
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / therapeutic use
  • Humans
  • Injections
  • Lidocaine / administration & dosage*
  • Lidocaine / therapeutic use
  • Male
  • Middle Aged
  • Pain Measurement
  • Prospective Studies
  • Statistics, Nonparametric
  • Tennis Elbow / drug therapy*
  • Treatment Outcome
  • Triamcinolone / administration & dosage*
  • Triamcinolone / therapeutic use


  • Anesthetics, Local
  • Glucocorticoids
  • Triamcinolone
  • Lidocaine