[Comparative results of non-surgical long term treatments of tennis elbow disease]

ABSTRACT

Tennis elbow or lateral epicondylitis disease is caused by overuse of forearm muscle, and tension of carpi radialis brevis tendon. Since there are no accepted criteria for treatment of the disease, this study was conducted with the aim of comparative efficacy of four non-surgical treatment procedures in Shahrekord in 2003. This double blind clinical trial investigated the efficacy of four non-surgical procedures in 120 patients [4 groups of 30] with mean age of 37 as follows 1] local corticosteroid injection [20 mg of methylprednisolone + lidocaine], 2] administration of NSAID [500 mg of naproxen b.i.d for 2 weeks], 3] forearm supportive bands, 4] physical therapy and progressive exercise. The elbows of all patients were immobilized by cast for two weeks and they were advised to avoid repetitive arm movement for 21 days. The first evaluation was carried out before treatment and the data were recorded. Overall recovery evaluation was conducted in the 1st, 3rd. 6th and 9th. months post - treatment through a 24-score standard and the data were analysed using SPSS version 12 software and paired t test. In the first evaluation the mean calculated score was 19.04 for all groups. In post-treatment period the results were as follows by the end of the first month the scores for 4 groups were 6, 8, 11 and 12 respectively, by the end of the 3rd month 9, 11, 8 and 8 respectively; by the end of the 6th month 9, 8, 6 and 5 respectively and by the end of the 9th months 8, 8, 5 and 3 respectively. Differences In mean score were statistically significant except the 3rd month which showed no significant difference [p=0.05]. Furthermore, final score of the first month showed the highest difference in corticosteroid-treated group with pre-treatment period compared to other groups [p=0.001]. By the end of the 9th month the change in final score in physical therapy group was the highest which showed a significant difference [p=0.005]. Local injection of corticosteroid is an effective method to relieve the pain in patients suffering from tennis elbow. However, recurrence of the disease is common during a tree-month period and the results at the end of the 9th month in physical therapy and exercise group is promising. Thus, the choice nonsurgical treatment for the disease is probably the initial corticosteroid injection followed by long term physical therapy