Corticosteroid and hyaluronic acid injection therapy in tennis elbow (lateral epicondylalgia)

Aim. Aim of the study was to compare the long-term effectiveness of the infiltration of local corticosteroids versus a protocol of one infiltration of local corticosteroid followed by 3 infiltrations of low molecular weight hyaluronic acid. Methods. This prospective study was conducted on 11 patients, practicing tennis as a hobby, who were diagnosed with humeral epicondylitis at our outpatient clinic between June 2012 and June 2013. Ratients were randomly assigned into two equal groups. Croup 1 received a single peritendinous injection of 1 mL methylprednisolone acetate 40 mg/mL with 0.8 mL lidocaine on the humeral epicondyle. Group 2 patients received a single peritendinous injection of 1 mL methylprednisolone acetate 40 mg/mL with 0.8 mL lidocaine plus an injection of 1 mL of low molecular weight hyaluronic acid 10 days later and once a week for two more times. Ratients were evaluated with the Italian version of the Disabilities of the Arm, Shoulder and Hand questionnaire before injection and at the 3 and 6 months follow-up. Results. We evaluate the patient before the beginning of the treatment, 3 months and 6 months later. There were no significant differences between the two groups with regard to gender, age, follow-up period, symptom duration, involved side and dominant limbs. The DASH scores of Group 2 were significantly lower than those of Group 1 at the 6 months follow-up (P=0.003). Conclusion. Long-term clinical success in the treatment of lateral epicondylitis could depend on the choice of the injection drugs. The injection of methylprednisolone acetate 40 mg/mL with 0.8 mL lidocaine plus injection of 1 mL of low molecular weight hyaluronic acid 10 days later and once a week for two more times appears to be more effective than the single injection of methylprednisolone acetate 40 mg/mL with 0.8 mL lidocaine in the long-term.