A Meta-Analysis of the Effect of Corticosteroid Injection for Enthesopathy of the Extensor Carpi Radialis Brevis Origin

Femke M A P Claessen; Balthasar A Heesters; Jimmy J Chan; Amir Reza Kachooei; David Ring

doi:10.1016/j.jhsa.2016.07.097

A Meta-Analysis of the Effect of Corticosteroid Injection for Enthesopathy of the Extensor Carpi Radialis Brevis Origin

J Hand Surg Am. 2016 Oct;41(10):988-998.e2. doi: 10.1016/j.jhsa.2016.07.097. Epub 2016 Aug 18.

Authors

Femke M A P Claessen¹, Balthasar A Heesters², Jimmy J Chan¹, Amir Reza Kachooei¹, David Ring³

Affiliations

¹ Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
² Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA.
³ Department of Hand Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA. Electronic address: david.ring@austin.utexas.edu.

PMID: 27546443
DOI: 10.1016/j.jhsa.2016.07.097

Abstract

Purpose: The null hypothesis that there is no effect of corticosteroid injection on visual analog scale for pain in patients with enthesopathy of the extensor carpi radialis brevis (eECRB) origin 6 months after treatment was tested. Our secondary hypotheses were that there is no effect of corticosteroid injection on pain intensity at 1 and 3 months after treatment; that there is no effect of corticosteroid injection on grip strength at 1, 3, and 6 months after treatment; and that there is no effect of corticosteroid injection on Disabilities of the Arm, Shoulder, and Hand scores at 1, 3 and 6 months after treatment.

Methods: EMBASE, PubMed Publisher, MEDLINE, OvidSP, Web of Science, Google Scholar, and the Cochrane Central were searched for relevant studies. Studies were eligible if there was (1) a description of corticosteroid injection treatment for eECRB; (2) randomized placebo injection-controlled trials with at least 10 adults included with eECRB; (3) a full-text article available with data describing the mean differences between the corticosteroid and the control groups and the outcome measures used; and (4) follow-up of at least 1 month. In total, 7 randomized controlled trials comparing the effect of corticosteroid injection with a placebo injection on symptoms of eECRB were included in our meta-analysis.

Results: We found no difference in pain intensity 6 months after injection of corticosteroids or placebo. Pain intensity was slightly, but significantly, lower 1 month, but not 3 months, after steroid injection. There were no significant differences in grip strength or Disabilities of the Arm, Shoulder, and Hand score at any time point.

Conclusions: This meta-analysis showed that there is no difference in pain intensity between corticosteroid injection and placebo 6 months after injection. We interpret the weight of evidence to date as suggesting that corticosteroid injections are neither meaningfully palliative nor disease modifying when used to treat eECRB.

Type of study/level of evidence: Therapeutic I.

Keywords: Corticosteroid; enthesopathy of the extensor carpi radialis brevis; meta-analysis; tennis elbow.

Publication types

Meta-Analysis
Review

MeSH terms

Adrenal Cortex Hormones / administration & dosage*
Enthesopathy / diagnosis
Enthesopathy / drug therapy*
Female
Follow-Up Studies
Hand Strength / physiology
Humans
Injections, Intralesional
Male
Pain Measurement / drug effects*
Randomized Controlled Trials as Topic
Range of Motion, Articular / physiology*
Risk Assessment
Severity of Illness Index
Tennis Elbow / diagnosis
Tennis Elbow / drug therapy*
Time Factors
Treatment Outcome

Substances

Adrenal Cortex Hormones