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Lateral Epicondylitis Injection Therapy: A Safety and Efficacy Analysis of Hyaluronate versus Corticosteroid Injections

Lauren Gorelick, Ayala Rozano Gorelick, Anwar Saab, Edward Ram

Lateral epicondylitis or tennis elbow, is a common elbow malady the extensor carpi radialis brevis origin. It is commonly treated by local injections of steroids are often associated with severe side effects and limited long term efficacy. Recently, hyaluronate is being increasingly used for the treatment of different degenerative processes of joints and soft tissue. Hyaluronate significantly and dose-dependently inhibits cell proliferation and decreased the expression level of mRNA for adhesion-related pro-collagens and cytokines. It is possible that such hyaluronate injections might improve results of injection therapy in tennis elbow syndrome. We reviewed 157 patients with tennis elbow that were treated in general, orthopaedic and hand clinics between 2003 and 2011. All patients were followed for up to one year according to a standardized protocol. Patients with rheumatoid arthritis and other rheumatoid diseases, after fractures or avascular necrosis about elbow, radial tunnel syndrome, and moderate and severe osteoarthritis were excluded. Patients were divided into three groups: first group treated by corticosteroid injection, second group treated by combination corticosteroid and hyaluronate injection and third group treated by hyaluronate injections only. The Hyaluronate treated group was clearly superior to the steroid group in efficacy measures (VAS score and DASH score) as well as side effect frequency. The combination therapy group was similar efficacy-wise to hyaluronate but similar to the steroid group in the number of associated side effects. In conclusion it seems that hyaluronate injection therapy is superior to steroid therapy in lateral epicondylitis.