Review Question - QID 8858

Physical therapy will result in more symptomatic improvement at 1 year. Corticosteroid injection (with or without physical therapy) results in the worst outcomes.

Corticosteroids are supposed to suppress inflammation, which is absent in lateral epicondylitis. They also work through an analgesic effect on neuropeptides, calcitonin gene-related peptide, and substance P, which are increased in tendinopathy. Corticosteroids might adversely affect tendon through suppressing fibroblast collagen and ECM production. Others propose that excessive or inappropriate early activity might incite recurrence.

Coombes et al. performed a randomized controlled trial comparing corticosteroid injection alone, placebo injection alone, corticosteroid injection plus physiotherapy and or placebo injection plus physiotherapy. They found that corticosteroid injection resulted in worse clinical outcomes after 1 year compared with placebo injection. Corticosteroid plus physiotherapy did not result in any significant differences compared with corticosteroid alone. However, physiotherapy alone in the absence of corticosteroid provides short-term benefit and the lowest recurrence rates and the highest recovery rates at 1 year.

Illustration A shows the common extensor origin.

Incorrect Answers:
Answer 1: Corticosteroid injection will result in LESS symptomatic improvement.
Answer 3: Corticosteroid injections will provide LESS symptomatic improvement than physical therapy.
Answer 4: Physical therapy will result in MORE improvement than no PT.
Answer 5: Physical therapy is the treatment of choice over other treatment.