Addition of Eccentric Elbow Exercises to Local Corticosteroid Injection for Tennis Elbow – A Prospective Randomized Study

Abstract

Lateral epicondylitis or Tennis elbow is a painful condition of the elbow that is characterized by pain and weakness of grip strength. It is usually due to a tendinopathy involving the origin of the ECRB and EDC tendons. Wide variety of treatment options exists. Injection corticosteroids are considered to be a good choice for short term improvement of the problem but has doubtful effects in the medium to long term.

This study is a randomized study that compares the short to medium term effect of addition of eccentric elbow strengthening exercises to local corticosteroid injections

This is a prospective randomized study with 1 year follow up. 24 subjects received corticosteroid injections alone while 26 underwent eccentric elbow strengthening additionally.

The patients were administered VAS , DASH score and tenderness on resisted dorsiflexion of wrist and middle finger initially. This was followed up after 2 weeks, 6 weeks, 3 months , 6 months and 1 year.

The groups were also well matched for age, sex, time since diagnosis.

The VAS, DASH and the tenderness scores were also similar in the two groups.

In the injection only group there was reduction of VAS from 7.08 to 2.83 in 2 weeks which showed a decreasing trend till 6months follow up. Similarly, the DASH scores decreased from 33.40 to 13.63 in 2 weeks and the same trend was seen till 6 months. However, at 1 year follow up both scores showed a slight increase.

In the injection plus exercises group the reduction of VAS and DASH scores continues till one year. Also comparing the two groups the injection plus exercise group shows significant improvement at 2weeks, 6 weeks and 1 year follow up

Addition of eccentric elbow strengthening exercises significantly improves the benefit of having a local corticosteroid injection for tennis elbow.