Effects of Heavy Slow Resistance Training Combined With Corticosteroid Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy: A 3-Arm Randomized Double-Blinded Placebo-Controlled Study.

Abstract

BACKGROUND:

Lateral elbow tendinopathy is a disabling tendon overuse injury. It remains unknown if a corticosteroid injection (CSI) or tendon needling (TN) combined with heavy slow resistance (HSR) training is superior to HSR alone in treating lateral elbow tendinopathy.

PURPOSE/HYPOTHESIS:

The purpose was to investigate the effects of HSR combined with either (1) a CSI, (2) TN, or (3) placebo needling (PN) as treatment for lateral elbow tendinopathy. We hypothesized that 12 weeks of HSR in combination with a CSI or TN would have superior effects compared with PN at 12, 26, and 52 (primary endpoint) weeks' follow-up on primary (Disabilities of the Arm, Shoulder and Hand [DASH] score) and secondary outcomes in patients with chronic unilateral lateral elbow tendinopathy.

STUDY DESIGN:

Randomized controlled trial; Level of evidence, 1.

METHODS:

A total of 60 patients with chronic unilateral lateral elbow tendinopathy were randomized to perform 12 weeks of home-based HSR with elastic band exercises combined with either (1) a CSI, (2) TN, or (3) PN, and at 12, 26, and 52 weeks, we assessed the primary outcome, the DASH score, and secondary outcomes: shortened version of the DASH (QuickDASH) score, pain (numerical rating scale [NRS] score), pain-free grip strength, and hypervascularization (power Doppler area).

RESULTS:

A CSI, TN, and PN improved patient outcomes equally based on the DASH (Δ20 points), QuickDASH (Δ21 points), and NRS (Δ2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Δ-2251 pixels, P = .0418). Except for the QuickDASH score (CSI increased score by Δ15 points compared with PN; P = .0427), there were no differences between the groups after 52 weeks.

CONCLUSION:

These results suggest that 12 weeks of HSR improved symptoms in both the short and the long term and that a CSI or TN did not amplify this effect. In addition, a CSI seemed to impair patient-reported outcomes compared with HSR alone at long-term follow-up.

REGISTRATION:

NCT02521298 (ClinicalTrials.gov identifier).

• Authors: Christian Couppé, Simon Døssing, Per Martin Bülow, Volkert Dirk Siersma, Camilla Kampp Zilmer, Christine Winther Bang, Rikke Høffner, Mathilde Kracht, Paul Hogg, Gabriella Edström, Michael Kjaer, Stig Peter Magnusson
• Journal: The American journal of sports medicine (Am J Sports Med) Vol. 50 Issue 10 Pg. 2787-2796 (08 2022) ISSN: 1552-3365 [Electronic] United States
• PMID: 35867777 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones

Topics

• Adrenal Cortex Hormones
• Elbow Tendinopathy (therapy)
• Humans
• Resistance Training (methods)
• Tendinopathy (therapy)
• Tendons
• Treatment Outcome