• Gulzar Saeed Ahmed
  • Muhammad Ali
  • Imtiaz Ahmed Trago


Background: Tennis elbow is a condition, characterised by pain and tenderness over the lateralepicondyle of the humerus, and pain on resisted dorsiflexion of the wrist, middle finger, or both. Theaim of this randomised controlled trial was to investigate the short term efficacy of local steroidinjection compared with oral and topical NSAIDs. Methods: Sixty patients (45 male and 15 female)were included in the study. The mean age was 42 years for men and 40 years for women. They wereplaced in group A and B (30 cases each). Group A received local steroid injection (triamcinolone 20mg mixed with lignocaine 2% 1 cc) and topical NSAID cream application (diclofenacdiethylammonium) twice a day, tab. diclofenac sodium 50 mg twice a day for 3 weeks. Group Breceived tab diclofenac 50 mg twice a day and, topical NSAID cream application twice a day for 3weeks. Assessment of patients was made 3 times; first at the start of the study, 2nd time after 6 weeks,and 3rd time after 12 weeks. A blinded assessor rated the elbow complaints of the patients at resisteddorsiflexion of wrist using VAS (0=no severity, 1–3 mild, 4–6 moderate, 7–9 sever, 10=maximumseverity). Results: At six weeks, 22 (73.33%) patient in group A had no pain as compared to 7(23.33%) patients in group B who were pain free (p<0.0001, χ2=38.75). At 12 weeks 27 (90%) patientsin group A were pain free compared to group B in which 7 (23.33%) patients were pain free (p<0.0001,2χ=27.56). Conclusion: In patients with tennis elbow, the use of local steroid injection in combinationwith topical and oral NSAIDs is superior to the use of combination of topical and oral NSAIDs. Betterresults with combination therapy using local steroid injection may be limited to the short term.Keywords: Tennis elbow, steroid, pain


Buchbinder R, Green S, Struijs P. Tennis elbow. Clin Evid

(online) 2008;05:1117.

Verhaar JA. Tennis elbow. Anatomical, epidemiological and

therapeutic aspects. Int Orthop 1994;18:263–7.

Wadsworth DG. Tennis elbow: Conservative, surgical and

manipulative treatment. BMJ (Clin Res Ed) 1987;294:621–3.

Murtagh J. Tennis elbow. Aust Fam Physician 1988;17:90–5.

Miller RH, Dlabach JA. Shoulder and elbow injuries. In:

Canale & Beaty (Eds) Campbell’s Operative Orthopaedics.,

th ed. Mosby: Elsevier;2007.

Noteboom T, Cruver R, Keller J, Kellogg B, Nitz AJ. Tennis

elbow: A review. J Orthop Sports Phys Ther 1994;19:357–66.

Vicenzino B, Wright A. Lateral epicondylagia: A review of

epidemiology, pathophysiology, etiology and natural history.

Phys Ther Rev 1996;1:23–34.

Khan KM, Cook JL, Kannus P, Maffuli N, Bonar SF. Time

to abandon the ‘tendinitis’ myth. BMJ 2002;324:626–7.

Rees JD, Wilson AM, Wolman RL. Current concepts in the

management of tendon disorders. Rheumatology


Hudak PL, Cole DC, Haines AT. Understanding prognosis to

improve rehabilitation: Example of lateral elbow pain. Arch

Phys Med Rehabil 1996;77:586–93.

Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis:

role of occupational factors. Best Pract Res Clin Rheumatol


Viola L. A critical review of the current conservative

therapies for tennis elbow (lateral epicondylitis). Australas

Chiropr Osteopathy 1998;7(2):53–67.

Vicenzino B. Lateral epicondylalgia: a musculoskeletal

physiotherapy perspective. Man Ther 2003;8:66–79.

Haker E. Lateral epicondylalgia (tennis elbow): a diagnostic

and therapeutic challenge [Dissertation]. Karolinska Institute;

Stockholm: 1991.

Smidt N, Van der Windt D, Assendelft W, Deville W,

Korthals-de Bos I, Bouter L. Corticosteroid injections,

physiotherapy, or a wait-and-see policy for lateral

epicondylitis: a randomized controlled trial. Lancet


Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B.

Mobilisation with movement and exercise, corticosteroid

injection, or wait and see for tennis elbow: randomized trial.

BMJ 2006;333:939.

Toker S, Kilinçoğlu V, Aksakalli E, Gülcan E, Ozkan K.

Short-term results of treatment of tennis elbow with antiinflammatory drugs alone or in combination with local

injection of a corticosteroid and anesthetic mixture Acta

Orthop Traumatol Turc 2008;42(3):184–7.




Most read articles by the same author(s)