Epicondylitis treated by local corticosteroid injection

Abstract

Tennis and golfer's elbow (lateral and medial epicondylitis) are readily treated with local injection of long-acting corticosteroid. In a clinical series of patients who had already failed to respond to oral drug treatment, rest and physiotherapy, thus acting as their own controls, 63% recorded an excellent result after corticosteroid injection and a further 26% had a good result. Inspection of anatomical specimens shows that the common extensor origin at the lateral epicondyle is variable in size and shape and that the male and female humeri are very different in character at this area. Epicondylitis is much more common in the female: 19 out of 27 in this clinical series. A technique is described for selecting the most tender spot, at which the injection should be sited. This is rarely at the epicondyle itself. Also, when the lesion is recurrent, tenderness is usually noted at a new site. For an average-sized tender lesion, a 1 ml injection of the mixture methylprednisolone 40 mg and lignocaine 10 mg per ml is ideal; however in order to reduce the incidence of skin atrophy, superficial lesions should receive a smaller volume of more dilute suspension.