Exercise and Therapeutic Ultrasound Compared with Corticosteroid Injection for Chronic Lateral Epicondylitis: A Randomized Controlled Trial.

BACKGROUND Lateral epicondylitis, or tennis elbow, is a common overuse syndrome of the extensor tendons of the forearm. When the condition is chronic or not responding to initial treatment, physical therapy is initiated. The objective of this study is to compare the effectiveness of corticosteroid injections with physiotherapeutic interventions (ultrasound and exercise) for the treatment of chronic lateral epicondylitis. MATERIAL AND METHODS We performed a randomized controlled trial of 12 weeks' duration in patients with chronic lateral epicondylitis. We randomly assigned 49 subjects to an exercise group (n=25), who received ultrasound and exercise, and a control group (n=24), who were treated with local infiltration of 1mL triamcinolone acetonide (10mg/mL) and 1mL lidocaine 2%. To evaluate the subjects, three instruments were used: pain intensity, measured with a Visual Analogue Scale (VAS), functional disability, measured with the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, and painfree grip strength. All subjects were evaluated before treatment and at the 6th and 12th week. RESULTS There were no significant differences between the two groups with regard to any variable at baseline (p>0.05). In the exercise group, significant improvements were demonstrated for VAS, PRTEE pain score, PRTEE function score and pain free grip strength, compared to the control group. The exercise group reported a significantly greater increase in all variables at 12 weeks than did the control group (p<0.001). CONCLUSION Our results suggest that ultrasound therapy and exercise are beneficial in the treatment of tennis elbow.