The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial

Arch Orthop Trauma Surg. 2013 Jun;133(6):757-63. doi: 10.1007/s00402-013-1721-x. Epub 2013 Mar 15.


Introduction: This study seeks to compare two treatment methods of lateral epicondylitis: corticosteroid injection (CSI) and a local anesthetic injection (LAI).

Materials and methods: In this single-blinded randomized clinical trial, 138 patients with the diagnosis of lateral epicondylitis were assigned either into CSI group receiving methylprednisolone 1 ml (49 patients) or LAI group (51 patients) receiving procaine 1 ml 2 % in a single dose at the maximal point tenderness site. The primary outcome measure was elbow disability using Quick DASH, and secondary outcome measures were pain intensity using Visual Analogue Scale (VAS) and recurrence rate at pretreatment visit and at 3-, 6- and 12-week post-treatment visits.

Results: There were no significant differences between the patients in both groups for demographic factors including age, gender, dominant hand, involved hand, and work pressure. Before treatment, the patients in both groups were suffering from the same rates of elbow disability and pain as measured by Quick DASH and VAS, respectively, (p > 0.05). In general, the recovery rate (comparison between pretreatment visit and last post-treatment visit) was significantly more effective and higher in CSI than LAI. CSI was dramatically more effective at 3-week visit, but less and less effective at 6- and 12-week visits. At 12-week visit the recurrence rate was 34.7 % (17 patients) in CSI group.

Conclusion: For lateral epicondylitis, CSI has the best short-term treatment results yet the highest recurrent rates. The combination of CSI with other treatment option or with a change in injection technique from single injection to peppering injection may be promising.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anesthetics, Local / administration & dosage*
  • Anti-Inflammatory Agents / administration & dosage*
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Injections, Intra-Articular
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / analogs & derivatives*
  • Methylprednisolone Acetate
  • Middle Aged
  • Procaine / administration & dosage*
  • Single-Blind Method
  • Tennis Elbow / drug therapy*


  • Anesthetics, Local
  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Methylprednisolone Acetate
  • Procaine
  • Methylprednisolone